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Published on: February 27, 2018
Short-course indomethacin prevents heterotopic ossification in a high-risk population following total hip
H C Amstutz1, V A Fowble, T P Schmalzried
1Joint Replacement Institute, Orthopaedic Hospital, Los Angeles, California 90007, USA.
Insights
A 10-day course of indomethacin effectively prevents significant heterotopic ossification after total hip arthroplasty. This safe and cost-effective regimen reduces bone formation in at-risk patients.
Area of Science:
- Orthopedic Surgery
- Pharmacology
Background:
- Heterotopic ossification (HO) is a common complication after total hip arthroplasty (THA).
- Patients at high risk for bone formation require effective preventive strategies.
Purpose of the Study:
- To evaluate the efficacy of a 10-day indomethacin course in preventing HO post-THA.
- To assess the safety and cost-effectiveness of this indomethacin regimen.
Main Methods:
- A consecutive series of male patients undergoing THA received a 10-day course of indomethacin.
- Patients were monitored for the development of heterotopic ossification (Brooker grades I-IV).
- Included primary, revision, and surface arthroplasty cases, with a subgroup of known previous bone formers.
Main Results:
- No significant HO (Brooker grade III or IV) was observed.
- Only 2 of 45 known previous bone formers developed new HO.
- Overall incidence of new HO was 7.6% (Brooker grade I or II).
Conclusions:
- A 10-day indomethacin regimen is effective in preventing significant HO after THA.
- The treatment demonstrates a favorable safety profile and is cost-effective.
- This regimen reduces the overall incidence of heterotopic ossification following hip arthroplasty.
Abstract:
The efficacy of a 10-day course of indomethacin in preventing heterotopic ossification after total hip arthroplasty was studied in a consecutive series of male patients who were at increased risk for bone formation. Between September 1991 and June 1994, all male patients (123 hips in 109 patients) who underwent total hip, revision, or surface arthroplasty were placed on a 10-day course of indomethacin. Of these, 106 patients (119 hips) successfully completed the 10-day course. There was no significant formation of heterotopic ossification (Brooker grade III or IV). From a group of 45 known heterotopic bone formers following previous total hip arthroplasty, only 2 developed new heterotopic ossification. Overall there were 9 (7.6%) new cases of heterotopic ossification: 7 Brooker grade I (5 primary and 2 revision cases) and 2 Brooker grade II (both primary cases). A 10-day course of indomethacin prevents the more significant grades of heterotopic ossification and is effective at reducing the incidence of heterotopic ossification following total hip arthroplasty. Further, this regimen appears safe and cost effective.
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