The Effects of NSAIDs on Foot and Ankle Arthrodesis Procedures, A Retrospective Chart Review

The opioid epidemic has forced practitioners to look to other means for pain control. This has made non-steroidal anti-inflammatory medications (NSAIDs) much more prevalent. Advantageous as it might seem, a closer look at the pharmacodynamics shows that by inhibiting COX enzymes, NSAIDs are inhibiting prostaglandin which could inhibit bone healing. Our objective is to determine if NSAID use during foot and ankle arthrodesis inhibits bone healing. We reviewed the electronic database of patients who underwent foot and/or ankle arthrodesis with the inclusion criteria of fusion CPT codes. Exclusion was younger than 18 years old, active infection, revisional arthrodesis, less than 3 months follow-up at Phoenix VA Healthcare System, no postoperative radiographs available, and death prior to fusion. One-hundred and sixty-one procedures in 155 patients were included and split into 2 groups. Group 1 included patients without non-union (n = 122) and Group 2, included patients with non-union (n = 39). NSAID use presented in 40 (33%) of procedures in Group 1 compared to 11 (28%) of procedures in Group 2 (Table 2). The mean days on NSAIDs was 51.2 ± 36.1 days in Group 1 compared to 52.2 ± 51.2 days in Group 2 with no statistical difference between groups. Time to fusion was longest in patients on NSAIDs (110 days) or both NSAIDs and active Tobacco use (114 days) and shortest in patients on active Tobacco (93 days) or no NSAIDS and tobacco use (93.61 days). NSAID use did not appear to affect ability to obtain joint fusion, but does appear to delay time to fusion.