Effect of aspirin on heterotopic ossification after total hip arthroplasty in men who have osteoarthrosis
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M J Pagnani1, P M Pellicci, E A Salvati
1Hip Service, Hospital for Special Surgery, Cornell University Medical College, New York City, NY 10021.
Insights
Aspirin significantly reduces severe heterotopic ossification after total hip arthroplasty. This study found a 48% rate of severe bone formation without aspirin versus only 3% with aspirin, highlighting its protective effect.
Area of Science:
- Orthopedic Surgery
- Pharmacology
- Radiology
Background:
- Heterotopic ossification (HO) is a common complication following total hip arthroplasty (THA).
- Risk factors and preventative measures for HO require further investigation.
Purpose of the Study:
- To evaluate the effect of aspirin on the severity of heterotopic ossification after primary cemented total hip arthroplasty.
Main Methods:
- Radiographic assessment of HO severity in 83 male patients post-THA.
- Review of medical records, blinded to radiographic findings.
- Comparison of HO severity between patients receiving aspirin and those not receiving aspirin.
Main Results:
- The overall incidence of heterotopic ossification was 72%.
- Severe HO (grade III or IV) occurred in 3% of patients receiving aspirin (n=58).
- Severe HO occurred in 48% of patients not receiving aspirin (n=25), a statistically significant difference (p < 0.0001).
Conclusions:
- Aspirin is highly effective in preventing severe heterotopic ossification after cemented THA.
- Intraoperative blood loss and operation duration were not associated with HO severity.
- Aspirin should be considered as a prophylactic agent for HO in THA patients.
Abstract:
The severity of heterotopic ossification was determined from the radiographs of eighty-three men in whom osteoarthrosis had been treated with a primary total hip arthroplasty with cement. The medical records of these patients were then reviewed, with the reviewer having no knowledge of the radiographic findings. A similar operative approach and technique had been used in all patients. There was no association between the amount of intraoperative loss of blood or the duration of the operation and the severity of formation of heterotopic bone. The over-all rate of occurrence of heterotopic ossification was 72 per cent. Of the fifty-eight patients who had received aspirin throughout their course in the hospital, two (3 per cent) had severe ectopic ossification (grade III or IV8). In contrast, twelve (48 per cent) of the twenty-five patients who had received no aspirin or in whom aspirin had been discontinued so that anticoagulation could be begun had severe heterotopic ossification. The difference in the severity of the ossification between the two groups is significant (p less than 0.0001).