Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?
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Heterotopic ossification is a common complication after total hip arthroplasty. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to prevent heterotopic ossifications effectively, however gastrointestinal complaints are reported frequently. In this study, we investigated whether etoricoxib, a selective cyclo-oxygenase-2 (COX-2) inhibitor that produces fewer gastrointestinal side effects, is an effective alternative for the prevention of heterotopic ossification.
We investigated the effectiveness of oral etoricoxib 90 mg for seven days in a prospective two-stage study design for phase-2 clinical trials in a small sample of patients (n = 42). A cemented primary total hip arthroplasty was implanted for osteoarthritis. Six months after surgery, heterotopic ossification was determined on anteroposterior pelvic radiographs using the Brooker classification.
No heterotopic ossification was found in 62 % of the patients that took etoricoxib; 31 % of the patients had Brooker grade 1 and 7 % Brooker grade 2 ossification.
Etoricoxib seems effective in preventing heterotopic ossification after total hip arthroplasty. This finding further supports the use of COX-2 inhibitors for the prevention of heterotopic ossification following total hip arthroplasty.
- Neal B, Gray H, MacMahon S, Dunn L (2002) Incidence of heterotopic bone formation after major hip surgery. ANZ J Surg 72(11):808–821 CrossRef
- Coventry MB, Scanlon PW (1981) The use of radiation to discourage ectopic bone. A nine-year study in surgery about the hip. J Bone Joint Surg Am 63(2):201–208
- Fransen M, Neal B (2004) Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty. Cochrane Database Syst Rev 3:CD001160
- Neal BC, Rodgers A, Clark T, Gray H, Reid IR, Dunn L, MacMahon SW (2000) A systematic survey of 13 randomized trials of non-steroidal anti-inflammatory drugs for the prevention of heterotopic bone formation after major hip surgery. Acta Orthop Scand 71(2):122–128 CrossRef
- Balboni TA, Gobezie R, Mamon HJ (2006) Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis. Int J Radiat Oncol Biol Phys 65(5):1289–1299 CrossRef
- Blokhuis TJ, Frolke JP (2009) Is radiation superior to indomethacin to prevent heterotopic ossification in acetabular fractures?: a systematic review. Clin Orthop Relat Res 467(2):526–530 CrossRef
- Burd TA, Hughes MS, Anglen JO (2003) Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunion. J Bone Joint Surg Br 85(5):700–705
- Cella JP, Salvati EA, Sculco TP (1988) Indomethacin for the prevention of heterotopic ossification following total hip arthroplasty. Effectiveness, contraindications, and adverse effects. J Arthroplasty 3(3):229–234 CrossRef
- Hunt RH, Harper S, Watson DJ, Yu C, Quan H, Lee M, Evans JK, Oxenius B (2003) The gastrointestinal safety of the COX-2 selective inhibitor etoricoxib assessed by both endoscopy and analysis of upper gastrointestinal events. Am J Gastroenterol 98(8):1725–1733 CrossRef
- Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z (2009) Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials. Int Orthop 35(1):3–8 CrossRef
- Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632
- Simon R (1989) Optimal two-stage designs for phase II clinical trials. Control Clin Trials 10(1):1–10 CrossRef
- van der Heide HJ, Koorevaar RC, Lemmens JA, van Kampen A, Schreurs BW (2007) Rofecoxib inhibits heterotopic ossification after total hip arthroplasty. Arch Orthop Trauma Surg 127(7):557–561 CrossRef
- van der Heide HJ, Rijnberg WJ, Van Sorge A, Van Kampen A, Schreurs BW (2007) Similar effects of rofecoxib and indomethacin on the incidence of heterotopic ossification after hip arthroplasty. Acta Orthop 78(1):90–94 CrossRef
- van der Heide HJ, Koorevaar RT, Schreurs BW, van Kampen A, Lemmens A (1999) Indomethacin for 3 days is not effective as prophylaxis for heterotopic ossification after primary total hip arthroplasty. J Arthroplasty 14(7):796–799 CrossRef
- Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K (2012) Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. Eur J Pain 16(6):838–848 CrossRef
- Macfarlane RJ, Ng BH, Gamie Z, El Masry MA, Velonis S, Schizas C, Tsiridis E (2008) Pharmacological treatment of heterotopic ossification following hip and acetabular surgery. Expert Opin Pharmacother 9(5):767–786 CrossRef
- Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, Lines C, Riddell R, Morton D, Lanas A, Konstam MA, Baron JA (2005) Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 352(11):1092–1102 CrossRef
- Weir MR, Sperling RS, Reicin A, Gertz BJ (2003) Selective COX-2 inhibition and cardiovascular effects: a review of the rofecoxib development program. Am Heart J 146(4):591–604 CrossRef
- Weber EW, Slappendel R, Durieux ME, Dirksen R, van der Heide H, Spruit M (2003) COX 2 selectivity of non-steroidal anti-inflammatory drugs and perioperative blood loss in hip surgery. A randomized comparison of indomethacin and meloxicam. Eur J Anaesthesiol 20(12):963–966 CrossRef
- Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?
Volume 37, Issue 4 , pp 583-587
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- 1. Department of Orthopaedics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
- 2. Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands