Reduction in utilization of radiation for heterotopic ossification prophylaxis following acetabular surgery during the COVID-19 pandemic

PURPOSE: Heterotopic ossification (HO) is common following acetabular surgery. Evidence comparing external beam radiation (XRT) and nonsteroidal anti-inflammatory drugs (NSAIDs) for HO prophylaxis remains conflicting. This study evaluated changes in XRT utilization during the COVID-19 pandemic and compared the efficacy of XRT versus NSAIDs. METHODS: A retrospective review was conducted of 180 patients undergoing open acetabular fracture fixation at a level 1 trauma center from 2018 to 2021. High-risk patients received XRT or indomethacin if XRT was declined. Outcomes included prophylaxis method, severe (Brooker 3 or 4) HO, and HO resection. RESULTS: XRT utilization decreased significantly during the pandemic (74.3% vs. 28.0%, P < 0.001). While severe HO rates remained similar (7.1% with XRT and 9.9% with NSAIDs) (P = 0.498), the only three HO resections were in the NSAIDs cohort. CONCLUSION: Despite reduced XRT use during COVID-19, HO outcomes were unchanged, suggesting both XRT and NSAIDs are effective prophylaxis options.