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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 9/2013

01-09-2013 | Symposium: Tscherne Festschrift

Heterotopic Ossification Rates After Acetabular Fracture Surgery Are Unchanged Without Indomethacin Prophylaxis

Authors: Sean M. Griffin, MD, Stephen H. Sims, MD, Madhav A. Karunakar, MD, Rachel Seymour, PhD, Nikkole Haines, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 9/2013

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Abstract

Background

We previously found no reduction in heterotopic ossification (HO) rates after acetabular surgery with indomethacin compared with a placebo. We subsequently abandoned routine indomethacin therapy after acetabular surgery but questioned whether the incidence had changed using a posterior approach.

Questions/purposes

We therefore determined (1) the incidence of HO after acetabular fracture surgery through a posterior approach; (2) the incidence of symptoms attributable to HO; and (3) the rate of reoperation for HO.

Methods

We retrospectively reviewed the records of all 423 patients with acetabular fractures following our clinical protocol change; of these, 120 were treated with a Kocher-Langenbeck approach and included. The presence of radiographic HO was documented a minimum of 10 weeks postoperatively using the classification of Brooker et al. Symptoms and reoperations were recorded.

Results

The overall incidence of radiographic HO was 47% (56 of 120 patients): 26% Class I–II 13% Class III, and 8% Class IV. Overall, 15% of patients developed symptoms; 3.3% underwent reoperations for excision of HO. There were no major differences between the incidence of moderate and severe HO in this study when compared with the indomethacin and placebo groups from the prior study.

Conclusions

Our incidence of moderate and severe HO has not changed since discontinuing indomethacin. These findings support our institutional decision to abandon routine indomethacin prophylaxis after acetabular surgery. We recommend improved surgical techniques to limit damage to the abductors and improved risk stratification of patients when considering treatment options for HO prophylaxis.

Levels of Evidence

Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Heterotopic Ossification Rates After Acetabular Fracture Surgery Are Unchanged Without Indomethacin Prophylaxis
Authors
Sean M. Griffin, MD
Stephen H. Sims, MD
Madhav A. Karunakar, MD
Rachel Seymour, PhD
Nikkole Haines, MD
Publication date
01-09-2013
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 9/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2871-4

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