Preventive effects of ibuprofen on periarticular heterotopic ossification after total hip arthroplasty: A randomized double-blind prospective study of treatment time

Abstract

We determined the efficacy and the minimum treatment time necessary for prophylaxis with nonsteroidal anti-inflammatory drugs (NSAIDs) for periarticular heterotopic ossification (HO) after total hip arthroplasty (THA). Using a double-blind placebo controlled design, 144 patients operated on with total hip arthroplasty for primary arthrosis were treated postoperatively with (1) ibuprofen for 3 weeks, (2) ibuprofen for 1 week and placebo for the next 2 weeks or (3) placebo for 3 weeks. Radiographic occurrence of periarticular heterotopic ossification and complications of the treatment were recorded for the first year. Both ibuprofen-treated groups showed significantly less HO than the placebo-treated group. There was no difference in HO between the patients treated for 8 or 21 days postoperatively. Both 8 and 21 days of treatment with ibuprofen following THA effectively prevents clinically significant degrees of HO. No serious short-term complications of the treatment were noted.

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

“…The two ibuprofentreated groups of patients developed less HO than the placebo group after 3 and 12 months of followup (Persson et al 1998).…”

“…In our original study (Persson et al 1998), 144 patients were operated with THA for osteoarthritis between 1987 and 1989, and randomized into 3 groups: 2 with short-term ibuprofen treatment (8 and 21 days) and 1 placebo group. After 10 years, 13 patients had been reoperated with exchange of one or both prosthetic components.…”

“…In a previous study we used a prospective, randomized, double-blind and placebo-controlled design involving 144 patients operated on with primary THA for osteoarthritis between 1987 and 1989, to investigate the efficacy of short-term medication with NSAIDs in prevention of the development of HO after THA (Persson et al 1998). Patients with rheumatoid disease or complications regarding fractures, and patients with contraindications to the use of NSAIDs (such as a history of liver or kidney failure, previous allergic reaction to salicylates or NSAIDs, or gastric ulcer/gastritis) were not included.…”

“…Clinically, NSAIDs have been found to retard healing of diaphyseal femur fractures and spinal fusions (Glassman et al 1998, Giannoudis et al 2000. In addition, several randomized clinical studies have provided evidence of the high efficacy of NSAIDs in preventing heterotopic ossification, which strongly suggests that these drugs also have effects on human bone metabolism (Schmidt et al 1988, Kjaersgaard-Andersen et al 1993, Gebuhr et al 1996, Persson et al 1998. As in the case of fracture healing, the surgical trauma of THA induces reparative processes, which are necessary for a durable prosthetic fixation by bone regeneration on and into the bone cement or the prosthesis.…”

“…For these reasons, we studied the long-term outcome of postoperative treatment with NSAIDs on prosthetic fixation. We had the opportunity to do so by performing a 10-year follow up on patients from a previous randomized study of our own, in which the effect of an NSAID on hetrotopic bone formation after hip arthroplasty was studied (Persson et al 1998). …”