Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?

Abstract

Purpose Heterotopic ossification is a common complication after total hip arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to prevent heterotopic ossifications effectively, however gastrointestinal complaints are reported frequently. In this study, we investigated whether etoricoxib, a selective cyclo-oxygenase-2 (COX-2) inhibitor that produces fewer gastrointestinal side effects, is an effective alternative for the prevention of heterotopic ossification. Methods We investigated the effectiveness of oral etoricoxib 90 mg for seven days in a prospective two-stage study design for phase-2 clinical trials in a small sample of patients (n=42). A cemented primary total hip arthroplasty was implanted for osteoarthritis. Six months after surgery, heterotopic ossification was determined on anteroposterior pelvic radiographs using the Brooker classification. Results No heterotopic ossification was found in 62 % of the patients that took etoricoxib; 31 % of the patients had Brooker grade 1 and 7 % Brooker grade 2 ossification. Conclusions Etoricoxib seems effective in preventing heterotopic ossification after total hip arthroplasty. This finding further supports the use of COX-2 inhibitors for the prevention of heterotopic ossification following total hip arthroplasty.

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 .…”

“…Oxygen tension, pH, micronutrients, and mechanical stimuli also impact bone formation 54 . Hypoxia-inducible factor 1-alpha (HIF-1a) is a key transcriptional regulator of the cellular response to ischemia through stimulation of vascular endothelial cell precursors 99,100 (Fig.…”

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

“…Lavernia et al [59] found celecoxib significantly more effective for HO prophylaxis when given 200 mg twice/-day for 28 days after THA compared to control group. At this stage, some studies recommend an oral HO prophylaxis for 4-6 weeks, whereas recent studies, as mentioned above, found 7-20 days to be effective, too [6,57,58].…”

“…indomethacin, diclofenac) [3,57]. Brunnekreef et al [58] found etoricoxib to be effective for HO prevention after cemented THA when given for 7 days. Lavernia et al [59] found celecoxib significantly more effective for HO prophylaxis when given 200 mg twice/-day for 28 days after THA compared to control group.…”

Comment on Brunnekreef et al.: Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?

“…by Brunnekreef et al [1] published in International Orthopaedics with great interest.In this study, the authors proved that etoricoxib, a selective cyclo-oxygenase-2 (COX-2) inhibitor, was effective for the prevention of heterotopic ossification (HO) following total hip arthroplasty (THA). However, we have several opinions which we would like to communicate with the authors.…”