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International Orthopaedics
Published in: International Orthopaedics 2/2006

01-04-2006 | Original Paper

Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol

Authors: Emilios E. Pakos, Evita J. Pitouli, Pericles G. Tsekeris, Vasiliki Papathanasopoulou, Kosmas Stafilas, Theodore H. Xenakis

Published in: International Orthopaedics | Issue 2/2006

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Abstract

The combination of radiotherapy and indomethacin for the prevention of heterotopic ossification (HO) in high-risk patients undergoing total hip arthroplasty (THA) has not been reported. The aim of the present study was to present the experience of our department with this combined therapeutic protocol. Fifty-four patients who underwent THA received a single dose of 7 Gy of postoperative radiotherapy and 75 mg of indomethacin for 15 days. Patients were analyzed for clinical and radiographical evidence of HO development at 1 year postoperatively. The overall radiographical incidence of HO was 20.4% (95% CI 10.6–33.5%), while only 1 patient with clinically significant HO was seen. Patients with secondary arthritis due to congenital hip disease had a statistically significantly higher incidence of HO compared with those with osteoarthrosis. The clinical assessment with the Merle d’Aubigné score showed that patients with radiographic documentation of HO had a lower mean score compared with those with no evidence of HO. No treatment-related side effects were seen. Combined radiotherapy and indomethacin was effective in preventing heterotopic ossification after total hip arthroplasty. The evaluation of this efficacy compared with radiotherapy or NSAIDs alone should be the future target of larger randomized designs.
Literature
1.
Anthony P, Keys H, Evarts CM, Rubin P, Lush C (1987) Prevention of heterotopic bone formation with early post operative irradiation in high risk patients undergoing total hip arthroplasty: comparison of 10.00 Gy vs 20.00 Gy schedules. Int J Radiat Oncol Biol Phys 13:365–369PubMed
2.
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 55:1629–1632PubMed
3.
Eggli S, Woo A (2001) Risk factors for heterotopic ossification in total hip arthroplasty. Arch Orthop Trauma Surg 121:531–535CrossRefPubMed
4.
Fransen M, Neal B (2004) Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty. Cochrane Database Syst Rev 3:CD001160PubMed
5.
Gregoritch SJ, Chadha M, Pelligrini VD, Rubin P, Kantorowitz DA (1994) Randomized trial comparing preoperative versus postoperative irradiation for prevention of heterotopic ossification following prosthetic total hip replacement: preliminary results. Int J Radiat Oncol Biol Phys 30:55–62PubMed
6.
Haas ML, Kennedy AS, Copeland CC, Ames JW, Scarboro M, Slawson RG (1999) Utility of radiation in the prevention of heterotopic ossification following repair of traumatic acetabular fracture. Int J Radiat Oncol Biol Phys 45:461–466CrossRefPubMed
7.
Handel M, Phillips O, Anders S, Kock FX, Sell S (2004) Dose-dependent efficacy of diclofenac-cholestyramine on pain and periarticular ossifications after total hip arthroplasty: a double-blind, prospective, randomised trial. Arch Orthop Trauma Surg 124:483–485CrossRefPubMed
8.
Healy WL, Lo TC, DeSimone AA, Rask B, Pfeifer BA (1995) Single-dose irradiation for the prevention of heterotopic ossification after total hip arthroplasty. A comparison of doses of five hundred and fifty and seven hundred centigray. J Bone Joint Surg Am 77:590–595PubMed
9.
Iorio R, Healy WL (2002) Heterotopic ossification after hip and knee arthroplasty: risk factors, prevention, and treatment. J Am Acad Orthop Surg 10:409–416PubMed
10.
Knelles D, Barthel T, Karrer A, Kraus U, Eulert J, Kolbl O (1997) Prevention of heterotopic ossification after total hip replacement. A prospective, randomised study using acetylsalicylic acid, indomethacin and fractional or single-dose irradiation. J Bone Joint Surg Br 79:596–602CrossRefPubMed
11.
Koelbl O, Seufert J, Pohl F, Tauscher A, Lehmann H, Springorum HW, Flentje M (2003) Preoperative irradiation for prevention of heterotopic ossification following prosthetic total hip replacement results of a prospective study in 462 hips. Strahlenther Onkol 179:767–773CrossRefPubMed
12.
Kolbl O, Knelles D, Barthel T, Kraus U, Flentje M, Eulert J (1997) Randomized trial comparing early postoperative irradiation vs. the use of non-steroidal anti-inflammatory drugs for prevention of heterotopic ossification following prosthetic total hip replacement. Int J Radiat Oncol Biol Phys 39:961–966PubMed
13.
Konski A, Pellegrini V, Poulter C, DeVanny J, Rosier R, Evarts CM, Henzler M, Rubin P (1990) Randomized trial comparing single dose versus fractionated irradiation for prevention of heterotopic bone: a preliminary report. Int J Radiat Oncol Biol Phys 18:1139–1142PubMed
14.
Lonardi F, Gioga G, Coeli M, Ruffo P, Agus G, Pizzoli A, Campostrini F (2001) Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty. Int Orthop 25:371–374CrossRefPubMed
15.
Merle d’Aubigné R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36:451–475PubMed
16.
Moore KD, Goss K, Anglen JO (1998) Indomethacin versus radiation therapy for prophylaxis against heterotopic ossification in acetabular fractures: a randomised, prospective study. J Bone Joint Surg Br 80:259–263CrossRefPubMed
17.
Pakos EE, Ioannidis JP (2004) Radiotherapy vs. nonsteroidal anti-inflammatory drugs for the prevention of heterotopic ossification after major hip procedures: a meta-analysis of randomized trials. Int J Radiat Oncol Biol Phys 60:888–895PubMed
18.
Reis HJ, Kusswetter W, Schellinger T (1992) The suppression of heterotopic ossification after total hip arthroplasty. Int Orthop 16:140–145CrossRefPubMed
19.
Romano CL, Duci D, Romano D, Mazza M, Meani E (2004) Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty. J Arthroplasty 19:14–18CrossRefPubMed
20.
Rosendahl S, Christoffersen JK, Norgaard M (1977) Para-articular ossification following hip replacement. 70 arthroplasties ad modum Moore using McFarland’s approach. Acta Orthop Scand 48:400–404PubMed
21.
Seegenschmiedt MH, Keilholz L, Martus P, Goldmann A, Wolfel R, Henning F, Sauer R (1997) Prevention of heterotopic ossification about the hip: final results of two randomized trials in 410 patients using either preoperative or postoperative radiation therapy. Int J Radiat Oncol Biol Phys 39:161–171PubMed
22.
Seegenschmiedt MH, Makoski HB, Micke O, German Cooperative Group on Radiotherapy for Benign Diseases (2001) Radiation prophylaxis for heterotopic ossification about the hip joint: a multicenter study. Int J Radiat Oncol Biol Phys 51:756–765PubMed
23.
Van Leeuwen WM, Deckers P, de Lange WJ (1998) Preoperative irradiation for prophylaxis of ectopic ossification after hip arthroplasty. A randomized study in 62 hips. Acta Orthop Scand 69:116–118PubMedCrossRef
24.
Vielpeau C, Joubert JM, Hulet C (1999) Naproxen in the prevention of heterotopic ossification after total hip replacement. Clin Orthop Relat Res 369:279–288CrossRefPubMed
25.
Wilkinson JM, Stockley I, Hamer AJ, Barrington NA, Eastell R (2003) Biochemical markers of bone turnover and development of heterotopic ossification after total hip arthroplasty. J Orthop Res 21:529–534CrossRefPubMed
Metadata
Title
Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol
Authors
Emilios E. Pakos
Evita J. Pitouli
Pericles G. Tsekeris
Vasiliki Papathanasopoulou
Kosmas Stafilas
Theodore H. Xenakis
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 2/2006
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-005-0054-y

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