Preoperative radiotherapy 20-28 hours before total hip arthroplasty versus NSAID prophylaxis for heterotopic…

Cohort studyInternational journal of radiation oncology, biology, physics· Aug 2026

Preoperative radiotherapy 20-28 hours before total hip arthroplasty versus NSAID prophylaxis for heterotopic ossification: A matched cohort study.

Maximilian Römer, Tobias Gürntke, Sonia Drozdz … Matthias Mäurer

ArthroplastyCohort studyTreatmentQ1IF 3.8

Preoperative radiotherapy showed no significant link to heterotopic ossification after total hip arthroplasty

Preoperative radiotherapy 20-28 hours before total hip arthroplasty versus NSAID prophylaxis for heterotopic ossification: A matched cohort study.

Maximilian Römer … Matthias Mäurer

International journal of radiation oncology, biology, physics · Aug 2026

Purpose

Heterotopic ossification (heterotopic ossification) frequently occurs after total hip arthroplasty (total hip arthroplasty).

Methods

We conducted a retrospective 1:3 matched cohort study comparing single-fraction preoperative radiotherapy (7 Gy) with postoperative diclofenac 50 mg twice daily for at least 14 days.

n = 344 patients

Results

no meaningful difference in ossification risk between radiotherapy and NSAID prophylaxis

OR by subgroup · 95% CI

More results

Mean age was comparable (radiotherapy: 70.0 ± 9.0 years; NSAID: 69.5 ± 9.0 years).

Both groups included 57% female and 43% male patients, and 10% received a cemented prosthesis.

Heterotopic ossification developed in 18.6% of radiotherapy patients versus 22.5% of NSAID patients.

More results

Exploratory analyses suggested potential sex-specific effect modification: radiotherapy was associated with lower odds of heterotopic ossification in men (OR 0.41, 95% CI 0.13-0.92) but not in women (OR 1.54, 95% CI 0.65-3.41), supporting further evaluation of sex as a potential modifier of prophylactic effect.

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Conclusion · 1 of 4

Radiotherapy delivered 20-28 hours before total hip arthroplasty was not associated with increased odds of heterotopic ossification compared with postoperative NSAID prophylaxis.

Conclusion · 2 of 4

Treatment-effect estimates across the primary, secondary, and ordinal analyses were directionally consistent.

Conclusion · 3 of 4

However, the retrospective design and width of the confidence intervals preclude conclusions regarding formal non-inferiority or equivalence between strategies.

Conclusion · 4 of 4

Exploratory analyses suggested that the prophylaxis effect may vary by sex, with a consistent signal of lower heterotopic ossification odds among men receiving radiotherapy.

Preoperative radiotherapy 20-28 hours before total hip arthroplasty versus NSAID prophylaxis for heterotopic ossification: A matched cohort study.

Preoperative radiotherapy 20-28 hours before total hip arthroplasty versus NSAID prophylaxis for heterotopic ossification: A matched cohort study.

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