title: Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey.
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.
  
  
  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.
authors.affiliation: Deptartment of Orthopaedics and Traumatology, Ospedale G. Bernabeo, Ortona, Italy. michele.barbato@libero.it
authors.forename: Michele
authors.initials: M
authors.lastname: Barbato
authors.forename: Ezio
authors.initials: E
authors.lastname: D'Angelo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Di Loreto
authors.forename: Angelo
authors.initials: A
authors.lastname: Menna
authors.forename: Alexander
authors.initials: A
authors.lastname: Di Francesco
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salini
authors.forename: Umberto
authors.initials: U
authors.lastname: Zoppi
authors.forename: Lino
authors.initials: L
authors.lastname: Cavasinni
authors.forename: Pancrazio
authors.initials: P
authors.lastname: La Floresta
authors.forename: Carlo Luca
authors.initials: CL
authors.lastname: Romanò
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D009999:Ossification, Heterotopic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib