Heterotopic ossification with total hip endoprostheses in various models of thrombosis prophylaxis

Knahr, K.; Salzer, M.; Eyb, R.; Frank, P; Blauensteiner, W.

doi:10.1016/s0883-5403(88)80047-0

Cited by 34 publications

(10 citation statements)

References 37 publications

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“…Our results using indomethacin are similar to those reported by other authors [15][16][17][18] (Table I). The incidence of HO which we observed in our groups treated by irradiation is also similar to those previously published 9,10,[19][20][21][22][23][24] (Table II), although it must be emphasised that most of these series had been of high-risk patients.…”

Section: Discussionsupporting

confidence: 92%

Prevention of Heterotopic Ossification After Total Hip Replacement

Knelles

Barthel

Karrer

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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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 ‫ן‬ 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 ‫ן‬ 50 mg for 7 and 14 days, and postoperative irradiation of 4 ‫ן‬ 3 Gy or 1 ‫ן‬ 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 ‫ן‬ 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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Section: Discussionsupporting

confidence: 92%

Prevention of Heterotopic Ossification After Total Hip Replacement

Knelles

Barthel

Karrer

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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“…In vitro studies have shown that there is almost no effect on mineralization and osteoinductivity in irradiated cells [38]. On the other hand, the inhibition of HO by indomethacin is probably due to a nonspecific suppression of the prostaglandin-induced inflammatory response which is present in the postoperative period [17], by inhibiting the prostaglandin synthesis mechanism [16,40] and a synchronous direct inhibition of the differentiation of mesenchymal cells into osteogenic cells [39,42]. Therefore, based on these probably different mechanisms of action, it could be hypothesized that the combination of these two different treatment modalities could be of increased efficacy compared to each of the treatments alone.…”

Section: Discussionmentioning

confidence: 99%

Combined Radiotherapy and Indomethacin for the Prevention of Heterotopic Ossification after Total Hip Arthroplasty

et al. 2009

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“…Knahr et al (1988) reported a retrospective study with a 2-week dosage of indomethacin which did pre- Ibuprofen suppository side-effects were the causes of withdrawal in 9 out of 10 patients. 6 discontinued the medication because of gastrointestinal side-effects.…”

Section: Discussionmentioning

confidence: 99%

“…Shorttime administration of indomethacin also inhibits bone formation experimentally (Tomkvist et al 1985). Knahr et al (1988) have reported that 2 or 3 weeks of indomethacin medication counteracts the formation of heterotopic ossification after hip arthroplasty. Ibuprofen has a low incidence of side-effects in comparison to other NSAIDs (Wiholm et al 1985).…”

Section: Ahrengart Gudmund Blomgren and Hans Tornkvistmentioning

confidence: 99%