Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey

Abstract

BackgroundIn spite of the proven efficacy of pharmacological prophylaxis of heterotopic ossification following total hip arthroplasty, its routine use is still debated, and no data are available regarding the adherence to its administration in clinical practice.Materials and methodsIn this prospective, observational, multicenter study, 480 consecutive patients operated on for primary total hip arthroplasty during the year 2009 were followed radiographically for 12 months after surgery in order to assess the incidence of periprosthetic heterotopic ossification. Surgeons were free to choose whether to administer pharmacological prophylaxis, and were asked to keep a record of the duration of the prophylaxis (if used) or the reasons for not using it. To facilitate the statistical analysis, all of the participating centers agreed to use only one drug (celecoxib) that had already proven to be effective.Results368 patients were administered celecoxib and 112 patients did not receive any prophylaxis. Reported reasons for not administering celecoxib prophylaxis were the surgeon’s opinion that prophylaxis was not needed on a routine basis (84/112 patients, 75%), previous history of gastrointestinal bleeding (17.8%), and concomitant cardiorenal pathologies (7.1%). The overall incidence of heterotopic ossification in the celecoxib-treated patients was 23% (no cases of Brooker grade 3 or 4 ossifications), compared to 55% in the untreated patients (Brooker grade 3 and 4: 8.9%). Multivariate analysis showed that celecoxib prophylaxis was the single most important variable when predicting the occurrence of heterotopic ossification.ConclusionsThis study confirms the efficacy and tolerability of celecoxib for the prophylaxis of heterotopic ossification after total hip arthroplasty, and shows how the surgeon’s belief that routine prevention is not required still plays an important role in the determination of this complication, together with the fear of possible unwanted side effects.

Heterotopic Ossification: Basic-Science Principles and Clinical Correlates

“…Prostaglandin E 2 is a major contributor to heterotopic ossification formation, fracture-healing, and bone regeneration [47][48][49][50][51][52][53][54][55][56][57][58][59] . Numerous recommendations exist with regard to dosing; indomethacin, a nonselective cyclooxygenase (COX)-1 and COX-2 inhibitor, is commonly administered at an oral dose of 75 mg twice per day or 25 mg three times per day for three to six weeks postoperatively 15,60,61 .…”

Pathogenesis and prevention strategies of heterotopic ossification in total hip arthroplasty: a narrative literature review and results of a survey in Germany

“…The most effective strategy against HO seems to be prophylaxis [6,56]. At this point, the local inflammatory prostaglandins in the traumatized muscle tissue, especially the cyclooxygenase (COX)-I and -II enzymes, are the main targets to prevent HO formations.…”

Demethylation of ITGAV accelerates osteogenic differentiation in a blast-induced heterotopic ossification in vitro cell culture model

“…In such cases, the incidence of HO can be as high as 63% when the mechanism of injury is a single high energy shock wave [ 14 , 15 ]. Current methods of prophylaxis, such as non-steroidal anti-inflammatory drugs [ 10 , [16] , [17] , [18] , [19] ] and radiotherapy [ 18 , 20 ], can reduce the incidence of trauma-induced HO, but are by no means a cure for the disease [ 21 , 22 ]. Thus, there is a need to develop model systems capable of breaking down the individual components causative of trauma-induced HO, to study their specific roles in disease onset, so that we can identify new therapeutics to prevent HO.…”