Do non-steroidal anti-inflammatory drugs cause endoprosthetic loosening? A 10-year follow-up of a randomized trial on ibuprofen for prevention of heterotopic ossification after hip arthroplasty

Abstract

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.

No effect of ketoprofen and meloxicam on bone graft ingrowth: A bone chamber study in goats

“…Similarly, Kjaersgaard-Andersen et al (1991) could not detect a difference in loosening or lucencies between patients who received indomethacin and the ones who did not. On the other hand, Persson et al (2005a) found a trend of higher revision rates in an indomethacin treatment group than in patients who did not receive any NSAIDs after 10 years of follow-up.…”

“…Theoretically, these NSAIDs inhibit bone restoration, which may result in a less stable or unstable implant (Persson et al 2005a). The effect of NSAIDs could be even more devastating if they are combined with bone grafts to reconstruct bone defects.…”

Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis

“…We were unable to find data on potential long-term complications of radiation or NSAIDs. However, the existence and clinical meaning of suggested potential long-term complications, such as soft tissue or osseous malignancies attributable to radiation [16,17] or prosthetic loosening attributable to NSAIDs [26], are more than questionable, especially considering the prohibitively long latencies of such events at the average age of most patients undergoing hip surgery. A recent study reported no increase in implant migration after 5 years in patients who had received NSAIDs or radiation to prevent HO [13].…”

Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: Follow-up of 75 hips for 15–18 years

“…The difference was not statistically significant, but reduced functional results with Brooker grade 3 and 4 ectopic bone formation have been shown by Hirota et al (1997). NSAIDs given prophylactically reduce ectopic bone formation, but they may have a negative effect on results in the longer term (Persson et al 2005).…”