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[Indomethacin--short-term therapy vs. single low dosage radiation for prevention of periarticular ossifications after
R Bremen-Kühne1, D Stock, C Franke
1Orthopädische Universitätsklinik Essen.
Introduction:
With a general incidence of about 40% periarticular ossifications (PAO) constitute one of the more frequent complications after total hip arthroplasty. A prospective, randomized therapy--study investigates the prophylactic values of Indomethacin-Short-Term-Therapy and Single-Dose-Radiatio, respectively.
Material And Methods:
Consecutive patients for elective, cementless THA were randomized; the Indomethacin-Group (A, n = 31 at the end of the study) was admitted 100 mg Indomethacin/supp. at the day of operation and 3 x 25 mg orally from postoperative day 1 to 10. Other NSAID were not given. The Radiatio-group (B; n = 19) was irradiated by a single dose of 6 Gy within postoperative days 1 to 4; no NSAID were admitted. Follow up was at dismissal and after 6 (NU 1) and 12 (NU 2) months. Incidence and severity of PAO and the clinical objective and subjective results were registered.
Results:
Age- and side-distribution as well as the etiologies were comparable in both groups. All patients took part in NU 1 and 90% in NU 2. There were no major differences in the incidence of postoperative PAO in both groups. In 68% (A) and 53% (B), resp., there were no PAO at dismissal and after six months, PAO of Brooker Grade I and II were seen in 30 (A) and 47% (B), resp., PAO of Grade III and IV--those having generally clinical relevance--did not occur at all. These results were confirmed after 12 months. The clinical objective result ameliorated between admission and dismissal by an average of 3.5 points and by another 2 points between dismissal and NU 2.
Discussion:
The results show that Indomethacin-Short-Term-Therapy as well as Single-Dose-Radiatio with 6 Gy can reliably prevent the occurrence of severe PAO. Both therapeutic concepts therefore can be employed as prophylaxis in primary endoprosthetic operations. The choice between the two procedures will then mainly be determined by given logistic conditions in the clinic, specific contraindications of the patient and financial considerations.