Pharmacological treatment of heterotopic ossification following hip and acetabular surgery.
Heterotopic ossification is a common complication following total hip arthroplasty and surgery following acetabular trauma. It is associated with pain and a decreased range of movement. Prophylaxis is achieved by either non-steroidal anti-inflammatory drug treatment or localised irradiation therapy. The objective of this study was to evaluate the evidence for pharmacological agents used for the prophylaxis of heterotopic ossification following hip and acetabular surgery. The study used a comprehensive literature search to identify all major clinical studies investigating the pharmacological agents used in the prophylaxis of heterotopic ossification following hip and acetabular surgery. It was concluded that indometacin remains the 'gold standard' for heterotopic ossification prophylaxis following total hip arthroplasty and is the only drug proven to be effective against heterotopic ossification following acetabular surgery. Following total hip arthroplasty, other non-steroidal anti-inflammatory drugs, including naproxen and diclofenac, are equally as effective as indometacin and can be considered as alternative first-line treatments. Celecoxib is also of equal efficacy to indometacin and is associated with significantly fewer gastrointestinal side effects. However, serious concerns were raised over the safety of selective cyclooxygenase-2 inhibitors for the cardiovascular system and these should be used cautiously.
Macfarlane
Robert J
RJ
University of Leeds, Academic Department of Trauma and Orthopaedics, School of Medicine, Clarendon Wing A, Leeds General Infirmary Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
Ng
Boon Han
BH
Gamie
Zakareya
Z
El Masry
Mohamed A
MA
Velonis
Stylianos
S
Schizas
Constantin
C
Tsiridis
Eleftherios
E
D000077:Acetabulum / Q000601:surgery; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D000068579:Celecoxib; D004008:Diclofenac / Q000627:therapeutic use; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects / Q000627:therapeutic use; D009288:Naproxen / Q000627:therapeutic use; D009999:Ossification, Heterotopic / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D004008:Diclofenac; D009288:Naproxen; D000068579:Celecoxib; D007213:Indomethacin