Preoperative irradiation versus the use of nonsteroidal anti-inflammatory drugs for prevention of heterotopic ossification following total hip replacement: the results of a randomized trial

Kölbl, Oliver; Knelles, D.; Barthel, Thomas; Raunecker, Florian; Flentje, Michael; Eulert, J.

doi:10.1016/s0360-3016(98)00204-1

Cited by 69 publications

(41 citation statements)

References 30 publications

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“…The failure of preoperative RT to prevent the development of HO varies from 5% to 48% (Table 3), depending on the Brooker grading, risk factors, and, to a certain extent, radiation doses. A study by Kölbl et al [16] is apparently discouraging as they reported an incidence of 48%; however, if only clinically significant HO is considered, the incidence becomes almost insignificant: HO grade III 2.2%, HO grade IV 0%. The authors emphasise that the higher incidence of mild or symptomatic Brooker grade I-II (36.9% and 8.7%, respectively) in the preoperative arm of the study is balanced by the advantages of the procedure, with lower costs and risks, more comfort to the patients and less demand on healthcare personnel.…”

Section: Resultsmentioning

confidence: 96%

“…Preoperative radiotherapy was used in an experimental model by Kantorowitz et al [11] and shown to be effective in preventing ectopic ossification. Preoperative trials [7,10,16,18,20,25] were initiated with the aim of testing the clinical efficacy whilst eliminating the drawbacks associated with postoperative administration. Two randomised studies [20] supported the efficacy of RT given 4 h preoperatively and showed that this approach was as effective as a postoperative regime.…”

Section: Resultsmentioning

confidence: 99%

“…Two randomised studies [20] supported the efficacy of RT given 4 h preoperatively and showed that this approach was as effective as a postoperative regime. The preliminary evaluation of the effectiveness of an "earlier" irradiation protocol, with a 16-h interval, was reported by Kölbl et al [16].…”

Section: Resultsmentioning

confidence: 99%

“…However, there are considerable administrative difficulties associated with giving this treatment so soon before surgery. Although the effects of early irradiation (24 h or more before surgery) are uncertain [11,19], promising results have been reported from a preliminary evaluation of treatment at an intermediate preoperative interval (less than 24 h) [16].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty

Lonardi

Gioga

Coeli³

et al. 2001

International Orthopaedics (SICOT)

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We gave a single fraction of 750 cGy preoperatively (within 16 h of surgery) to 143 patients prior to total hip arthroplasty. The patients were evaluated for heterotopic ossification at 1, 3 and 6 months. The preoperative radiation did not affect the surgical procedure. After a median follow-up of 12 (6-24) months we encountered six patients with heterotopic ossifications of Brooker grade I-II. Potential late risks from ionising radiation should be considered when treating younger patients.Résumé Cent quarante trois patients ont reçus avant le remplacement prothétique de la hanche (en moyenne 16 heures avant l'intervention) une radiothérapie par une dose unique de 750 cGy. Les patients ont été évalués pour recherche des ossification hétérotopiques à 1, 3 et 6 mois. L'irradiation préopératoire n'a pas affecté la procédure chirurgicale. Avec une médiane de suivi de 12 (6-24) mois six patients ont présentés des ossifications hétérotopiques de niveau Brooker I-II. Les risques tardifs potentiels des radiations ionisantes doivent être pris en compte lorsque on traite des patients jeunes.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty

Lonardi

Gioga

Coeli³

et al. 2001

International Orthopaedics (SICOT)

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“…Recent studies have documented a beneficial effect of NSAID and radiation in the prevention of HO. 18,[22][23][24][25][26] However, patients with already established HO undergoing surgical removal have a very high-risk of recurrence. In these high-risk cases a recurrence rate of over 50% has been reported even with prophylactic radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Amino-bisphosphonates in heterotopic ossification: first experience in five consecutive cases

et al. 2005

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Study design: Retrospective, observational study in five consecutive cases. Objectives: The management of heterotopic ossification (HO), a frequent complication after spinal cord injury (SCI) and after orthopaedic surgery, is a therapeutic challenge with high recurrence rates of over 50%. Conflicting data were reported for Etidronate. The use of the more potent new generation of amino-bisphosphonates has been put forward in different inflammatory, dysmorphogenic bone disease. In order to try and halt the underlying dysfunctional bone metabolism we have studied the action of pamidronate in five consecutive high-risk patients with established HO of different etiology undergoing surgical removal. Setting: University Hospital of Basel, Switzerland, Division of Endocrinology, Diabetology and Clinical Nutrition and the Department of Orthopedic Surgery. Methods: In all five patients, ranging from 47 to 68 years of age, we used continuous pamidronate infusions perioperatively at a dosage of 120 mg in the first 12 h and subsequent reduction to 75-60-30-15 mg/12 h over a period of 10-14 days. Results: None of these patients showed clinical, radiographical and laboratory signs of HO recurrence or new forming HO in the follow-up 5-54 month after surgery. Potential side effects of high-dose bisphosphonate therapy such as osteoporosis and osteomalacia were not reported in any case. Conclusion: We postulate that pamidronate might have pronounced beneficial effects in highrisk patients with established HO undergoing excision surgery. Since the therapeutic window of amino-bisphosphonates has not yet been defined and the minimal necessary doses for preventing new HO are unknown, further studies are encouraged to confirm our findings and to identify the necessary dosage and duration of treatment and to pinpoint, which patients will benefit most from this treatment.Spinal Cord (2005) 43, 604-610.

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Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty

Fransen

Neal

2004

Cochrane Database of Systematic Reviews

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Preoperative irradiation versus the use of nonsteroidal anti-inflammatory drugs for prevention of heterotopic ossification following total hip replacement: the results of a randomized trial

Cited by 69 publications

References 30 publications

Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty

Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty

Amino-bisphosphonates in heterotopic ossification: first experience in five consecutive cases

Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty

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