We determined the efficacy and the minimum treatment time necessary for prophylaxis with nonsteroidal anti-inflammatory drugs (NSAIDs) for periarticular heterotopic ossification (HO) after total hip arthroplasty (THA). Using a double-blind placebo controlled design, 144 patients operated on with total hip arthroplasty for primary arthrosis were treated postoperatively with (1) ibuprofen for 3 weeks, (2) ibuprofen for 1 week and placebo for the next 2 weeks or (3) placebo for 3 weeks. Radiographic occurrence of periarticular heterotopic ossification and complications of the treatment were recorded for the first year. Both ibuprofen-treated groups showed significantly less HO than the placebo-treated group. There was no difference in HO between the patients treated for 8 or 21 days postoperatively. Both 8 and 21 days of treatment with ibuprofen following THA effectively prevents clinically significant degrees of HO. No serious short-term complications of the treatment were noted.

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Bone formation outside the skeleton, heterotopic ossification (HO), is a common finding on radiographs from patients who have undergone arthroplasty of the hip, knee, shoulder, or elbow. Only a minority (5%-10%) of the patients with HO suffer from any consequence of the condition. However, because of the great number of joint replacements performed, the number of patients with decreased function that can be attributed to HO is significant. The risk for severe HO after total hip arthroplasty is increased in 1) patients who have developed HO after previous surgery, 2) men with hypertrophic osteoarthrosis and, 3) in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. The same risk factors are probably valid for other joints as well. Two preventive treatments for HO after hip arthroplasty, nonsteroidal anti-inflammatory drugs and local radiation, are effective and reasonably well documented but are associated with potential side effects. Thus, a treatment protocol to prevent HO must identify the patients at risk for severe HO and recommend them treatment with one of these two modalities. Based on the current literature, we suggest that the patients at risk for severe HO be treated with 1) nonsteroidal anti-inflammatory drugs from the day of surgery for 7-10 days or 2) preoperative (or postoperative) radiation in a single dose.

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are known to be potent inhibitors of new bone formation. We investigated whether NSAIDs given at surgery influence the long-term results after total hip arthroplasty (THA).Patients and methods We performed a 10-year follow-up on 142 of 144 patients who had taken part in a randomized trial on the preventive effects of the NSAID ibuprofen on heterotopic ossification after THA. 96 patients were treated with ibuprofen: 48 for 1 week postoperatively, 48 for 2 weeks postoperatively, and 48 patients were not treated.Results 13 patients had been revised. All revisions except 1 belonged to groups treated with ibuprofen. The 10-year risk for revision was significantly higher in the ibuprofen-treated patients (p = 0.05). Eleven of the revisions occurred due to fractures of the femur (2) or aseptic loosening (9), reasons that may be attributed to negative effects of ibuprofen. For these patients, the 10-year risk for revision was not statistically significantly different between treated and untreated patients (p = 0.08). In addition to the revised patients, 94 other patients were alive at the 10-year follow-up and 84 underwent radiographic examination. 9 loose prostheses were found radiographically, but these were equally distributed between ibuprofen-treated and untreated hips.Interpretation The high proportion of revisions in the ibuprofen groups, in combination with clinical and experimental evidence of inhibitory effects on new bone formation of NSAIDs, warrants further investigation of the effects of these drugs on prosthetic fixation.

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