Summary
Prophylactic treatment with indomethacin or ibuprofen to prevent periarticular heterotopic ossification (PHO) was investigated in a consecutive series of 200 total hip replacements (THR) performed for primary coxarthrosis in 170 patients. No widespread PHO (grades III and IV) occurred in 166 THR treated with indomethacin or ibuprofen from the 1st to the 21st postoperative day. Only one patient exhibited moderate (grade-II) ossification. In contrast, the incidence of PHO grades III and IV was found to be high (23%) in the 35 THR for which the patients did not receive prophylaxis according to intention. It was concluded that 3 weeks' postoperative treatment with indomethacin or ibuprofen is sufficient to prevent the development of clinically significant heterotopic ossification.
Similar content being viewed by others
References
Allen HL, Wase A, Bear WT (1980) Indomethacin and aspirin: effect of non-steroidal anti-inflammatory agents on the rate of fracture repair in the rat. Acta Orthop Scand 51:595–600
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg [Am] 55:1629–1632
Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg [Br] 54:61–76
Connor JM (1983) Soft tissue ossification. Springer, Berlin Heidelberg New York, p 27
Coventry MB, Scanlon PW (1981) The use of radiation to discourage ectopic bone. J Bone Joint Surg [Am] 63:201–208
Craven PL, Urist MR (1971) Osteogenesis by radioisotope-labelled cell populations in implants of bone matrix under the influence of ionizing radiation. Clin Orthop 76:231–243
Dahl HK (1975) Clinical observations (in Norwegian). Symposium, MSD, pp 37–46
DeLee J, Ferrari A, Chamley J (1976) Ectopic bone formation following low-friction arthroplasty of the hip. Clin Orthop 121:53–59
Elmstedt E, Lindholm TS, Nilsson OS, Törnkvist H (1985) Effect of ibuprofen on heterotopic ossification after hip replacement. Acta Orthop Scand 56:25–27
Hierton C, Blomgren G, Lindgren U (1983) Factors associated with heterotopic bone formation in cemented total hip prostheses. Acta Orthop Scand 54:698–702
MacLennan I, Keys HM, McCollister Evarts C, Rubin P (1984) Usefulness of postoperative hip irradiation in the prevention of heterotopic bone formation in a high-risk group of patients. Int J Radiat Oncol Biol Phys 10:49–53
Morrey BF, Adams RA, Cabanela ME (1984) Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Clin Orthop 188:160–167
Parkinson JR, McCollister Evarts C, Hubbard LF (1982) Radiation therapy in prevention of heterotopic ossification after total hip arthroplasty. The hip. Proceedings of 10th open scientific meeting of The Hip Society, pp 211–227
Ritter MA, Vaughan RB (1977) Ectopic ossification after total hip replacement. J Bone Joint Surg [Am] 59:345–351
Ritter MA, Gioe TJ (1982) The effect of indomethacin on para-articular ectopic ossification following total hip arthroplasty. Clin Orthop 167:113–117
Ritter MA, Sieber J (1985) Prophylactic indomethacin for the prevention of heterotopic bone formation following total hip arthroplasty. Clin Orthop 196:217–225
Rosendahl S, Krogh Christoffersen J, Norgaard M (1977) Para-articular ossification following hip replacement. Acta Orthop Scand 48:400–404
Rö J, Sudmann E, Maron PF (1976) Effect of indomethacin on fracture healing in rats. Acta Orthop Scand 47:588–599
Sudmann E (1975) Effect of indomethacin on bone remodelling in rabbit ear chambers. Acta Orthop Scand [Suppl] 160:91–115
Sudmann E, Bang G (1979) Indomethacin-induced inhibition of haversian remodelling in rabbits. Acta Orthop Scand 50:621–627
Thomas BJ, Amstutz HC (1985) Results of administration of diphosphonate for prevention of heterotopic ossification after total hip arthroplasty. J Bone Joint Surg [Am] 67:400–403
Törnkvist H, Nilsson OS, Bauer FCH, Lindholm TS (1983) Experimentally induced heterotopic ossification in rats influenced by anti-inflammatory drugs. Scand J Rheumatol 12:177–180
Törnkvist H, Bauer HCF, Nilsson OS (1985) Influence of indomethacin on experimental bone metabolism in rats. Clin Orthop 193:264–270
Törnkvist H, Bauer HCF, Nilsson OS (1985) The osteoinductive properties of bone matrix from rats treated with indomethacin. Scand J Rheumatol 14:197–200
Urist MR, DeLange RJ, Finerman GAM (1983) Bone cell differentiation and growth factors. Science 220:680–686
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sodemann, B., Persson, P.E. & Nilsson, O.S. Prevention of periarticular heterotopic ossification following total hip arthroplasty. Arch. Orth. Traum. Surg. 107, 329–333 (1988). https://doi.org/10.1007/BF00381057
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00381057