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Journal of Orthopaedics and Traumatology

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Open Access 01-06-2012 | Original Article

Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey

Authors: Michele Barbato, Ezio D’Angelo, Giuseppina Di Loreto, Angelo Menna, Alexander Di Francesco, Vincenzo Salini, Umberto Zoppi, Lino Cavasinni, Pancrazio La Floresta, Carlo Luca Romanò

Published in: Journal of Orthopaedics and Traumatology | Issue 2/2012

Abstract

Background

In spite of the proven efficacy of pharmacological prophylaxis of heterotopic ossification following total hip arthroplasty, its routine use is still debated, and no data are available regarding the adherence to its administration in clinical practice.

Materials and methods

In this prospective, observational, multicenter study, 480 consecutive patients operated on for primary total hip arthroplasty during the year 2009 were followed radiographically for 12 months after surgery in order to assess the incidence of periprosthetic heterotopic ossification. Surgeons were free to choose whether to administer pharmacological prophylaxis, and were asked to keep a record of the duration of the prophylaxis (if used) or the reasons for not using it. To facilitate the statistical analysis, all of the participating centers agreed to use only one drug (celecoxib) that had already proven to be effective.

Results

368 patients were administered celecoxib and 112 patients did not receive any prophylaxis. Reported reasons for not administering celecoxib prophylaxis were the surgeon’s opinion that prophylaxis was not needed on a routine basis (84/112 patients, 75%), previous history of gastrointestinal bleeding (17.8%), and concomitant cardiorenal pathologies (7.1%). The overall incidence of heterotopic ossification in the celecoxib-treated patients was 23% (no cases of Brooker grade 3 or 4 ossifications), compared to 55% in the untreated patients (Brooker grade 3 and 4: 8.9%). Multivariate analysis showed that celecoxib prophylaxis was the single most important variable when predicting the occurrence of heterotopic ossification.

Conclusions

This study confirms the efficacy and tolerability of celecoxib for the prophylaxis of heterotopic ossification after total hip arthroplasty, and shows how the surgeon’s belief that routine prevention is not required still plays an important role in the determination of this complication, together with the fear of possible unwanted side effects.

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Title: Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey
Authors: Michele Barbato
Ezio D’Angelo
Giuseppina Di Loreto
Angelo Menna
Alexander Di Francesco
Vincenzo Salini
Umberto Zoppi
Lino Cavasinni
Pancrazio La Floresta
Carlo Luca Romanò
Publication date: 01-06-2012
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 2/2012
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-012-0180-4

At a glance: The STEP trials

Springer Medicine

Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey

Abstract

Background

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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