Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty☆

https://doi.org/10.1016/S0883-5403(03)00279-1Get rights and content

Abstract

A cyclo-oxygenase (COX)-1 and COX-2 inhibitor (indomethacin) and a selective COX-2 inhibitor (celecoxib) were compared in the prevention of heterotopic ossification after total hip arthroplasty. In 250 patients receiving indomethacin and in 150 patients receiving celecoxib for 20 days after surgery, an overall incidence of heterotopic ossification of 17.5% and 14.3% was seen, respectively (difference not statistically significant: P > .05). No grade III or IV ossifications were seen in either group. Twenty-one patients in the indomethacin group (8.4%) and 3 patients in the celecoxib group (2.0%) required treatment discontinuation, because of side effects (P < .05). Celecoxib, a selective COX-2 inhibitor, shows the same efficacy as indomethacin in the prevention of heterotopic ossification after hip prosthesis with significantly fewer side effects.

Section snippets

Material and methods

This study included 400 patients affected by coxarthrosis and undergoing surgery to implant a noncemented total hip arthroplasty at the Gaetano Pini Institute of Milano. In all the cases, a direct lateral transgluteal approach, without trocantherotomy, was used. Exclusion criteria were previous surgery on the same hip, ankylosing spondilitis, diffuse idiopathic skeletal hyperostosis, and neurologic diseases, all conditions that are suspected to increase the risk of development of heterotopic

Results

Heterotopic ossifications developed in 40 patients (17.5%) who completed the indomethacin treatment. Grade I ossifications were seen in 28 patients (12.2%), and grade II in 12 patients (5.2%). Heterotopic ossification developed in 21 patients (14.3%) who completed the celecoxib treatment. Grade I ossifications were seen in 15 patients (10.2%), and grade II in 6 patients (4.1%). The difference in the incidence of heterotopic ossifications between the 2 groups was not statistically significant (P

Discussion

We believe that prophylaxis of heterotopic bone formation is today a mandatory part of the treatment of every patient who undergoes hip surgery, particularly after total hip arthroplasty. In fact, even if risk factors for developing ectopic ossification are well known 13, 15, as stated by Kolbl and Knelles et al. [22], “on an absolute scale considerably more patients without risk factors develop heterotopic ossification because the number of patients with risk factors is low compared to all

References (32)

  • W.H. Harris

    Clinical results using the Mueller-Charnely total hip prosthesis

    Clin Orthop

    (1972)
  • M. Matons et al.

    Myositis ossificans following total hip replacement

    J Bone Joint Surg Am

    (1975)
  • B.F. Kavanagh et al.

    Revision total hip arthroplasty

    J Bone Joint Surg Am

    (1985)
  • A.J.G. Nollen et al.

    Para-articular ossifications after total hip replacement

    Acta Orthop Scand

    (1973)
  • M.A. Ritter et al.

    Ectopic ossification after total hip arthroplastypredisposing factors, frequency, and effect on results

    J Bone Joint Surg Am

    (1977)
  • G. Randelli et al.

    Rigidità articolare d’ancatrattamento chirurgico a cielo aperto

    Giornale Italiano di Ortopedia e Traumatologı̀a

    (1995)

    • Cited by (0)

    ☆

    No benefits or funds were received in support of this study.

    View full text
    Copyright © 2004 Elsevier Inc. All rights reserved.