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PREVENTION OF HETEROTOPIC OSSIFICATION AFTER TOTAL HIP REPLACEMENT

A PROSPECTIVE, RANDOMISED STUDY USING ACETYLSALICYLIC ACID, INDOMETHACIN AND FRACTIONAL OR SINGLE-DOSE IRRADIATION

D. Knelles, MD1; T. Barthel, MD1; A. Karrer1; U. Krause1; J. Eulert, MD, Professor and Head of Department1; and O. Kölbl, MD2

1 Department of Orthopaedic Surgery, Julius-Maximilians-University of Würzburg, König-Ludwig Haus, Brettreichstrasse 11–13, D-97074 Würzburg, Germany.
2 Department of Radiation Therapy, Julius-Maximilians-University of Würzburg, Josef-Schneider-Strasse, D-97080 Würzburg, Germany.

Correspondence should be sent to Dr D. Knelles.

We have carried out a prospective, randomised study of prophylaxis for heterotopic ossification (HO) comparing indomethacin for 7 and 14 days, acetylsalicylic acid, and fractional (4 x 3 Gy) or single exposure of 5 or 7 Gy irradiation after operation.

We initially had 723 patients (733 hip replacements), but after withdrawals there were 685 hips of which 18.4% developed HO; 14% were grade I, 2.9% grade II and 1.5% grade III of the Brooker classification.

We compared the results between these groups with those of a matched control series and found that indomethacin, 2 x 50 mg for 7 and 14 days, and postoperative irradiation of 4 x 3 Gy or 1 x 7 Gy, significantly reduced the development of HO compared with the control group. Patients in the acetylsalicylic acid group and those with a single irradiation of 5 Gy after operation developed significantly more ossification than those in the indomethacin and other irradiation groups.

We suggest the use of 2 x 50 mg of indomethacin with mucoprotection for seven days as prophylaxis against HO after total hip replacement for all patients. A single irradiation of 7 Gy is recommended for patients who have developed HO after previous operations or to whom administration of indomethacin is contraindicated.




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(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General