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Strahlentherapie und Onkologie

, Volume 185, Issue 8, pp 500–505 | Cite as

Combined Radiotherapy and Indomethacin for the Prevention of Heterotopic Ossification after Total Hip Arthroplasty

  • Emilios E. PakosEmail author
  • Kosmas S. Stafilas
  • Pericles G. Tsekeris
  • Aggelos N. Politis
  • Gregory Mitsionis
  • Theodore A. Xenakis
Original Article

Background and Purpose:

Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. The aim of this study was to evaluate the efficacy of combined radiotherapy and indomethacin as compared to indomethacin alone for the prevention of HO after hip arthroplasty.

Patients and Methods:

96 patients were prospectively enrolled to receive either a single dose of postoperative radiotherapy of 7.0 Gy and indomethacin for the first 15 postoperative days or indomethacin alone for the same period. A historical group of 50 patients that received indomethacin alone served as control. Primary endpoint was the radiographic evidence of HO at 6 months. Secondary endpoints were the evaluation of factors related to HO development, side effects from each treatment, and group differences in the clinical assessment with the Merle d’Aubigné Score.

Results:

Four patients in the combined-therapy group developed HO compared to 13 patients in the indomethacin group (p < 0.05) and 13 patients in the historical group (p < 0.05). One patient each in the combined group and the historical group developed Brooker III HO (nonsignificant difference). Duration of surgery and congenital hip disease were associated with HO development in the indomethacin groups, while age and congenital hip disease showed such an association in the combined-therapy group. The side effects and mean Merle d’Aubigné Score did not differ significantly between the three groups.

Conclusion:

Combined radiotherapy and indomethacin was more efficacious in preventing HO after total hip arthroplasty compared to indomethacin alone and should be considered for future investigation.

Key Words:

Heterotopic ossification Total hip arthroplasty Radiotherapy Indomethacin Congenital hip disease 

Kombination von Radiotherapie und Indometacin zur Prävention heterotoper Ossifikationen nach Implantation einer Hüfttotalendoprothese

Hintergrund und Ziel:

Heterotope Ossifikationen (HO) sind eine häufige Komplikation nach Implantation einer Hüfttotalendoprothese. In dieser Studie wurde die Wirksamkeit der Kombination von Radiotherapie und Indometacin im Vergleich mit alleinigem Indometacin zur HO-Prävention nach endoprothetischem Hüftgelenkersatz evaluiert.

Patienten und Methodik:

96 Patienten wurden prospektiv eingeschlossen und erhielten in den ersten 15 Tagen nach dem Eingriff entweder eine postoperative Radiotherapie mit einer Einzeldosis von 7,0 Gy und Indometacin oder nur Indometacin. Eine historische Gruppe von 50 nur mit Indometacin behandelten Patienten diente als Kontrolle. Primärer Endpunkt war die radiologische Evidenz von HO nach 6 Monaten. Sekundäre Endpunkte umfassten die Evaluierung von die HO-Entwicklung begünstigenden Faktoren, von Nebenwirkungen der jeweiligen Behandlung und von Gruppenunterschieden in der klinischen Beurteilung mit dem Score nach Merle d’Aubigné.

Ergebnisse:

Vier Patienten in der kombinierten Therapiegruppe entwickelten HO im Vergleich zu 13 Patienten in der Indometacingruppe (p < 0,05) und 13 Patienten in der historischen Gruppe (p < 0,05). Je ein Patient in der kombinierter und der historischen Gruppe entwickelte HO Brooker III (nichtsignifikanter Unterschied). Operationsdauer und kongenitale Hüftdysplasie waren in den Indometacingruppen mit der Entwicklung von HO assoziiert, während Alter und kongenitale Hüftdysplasie in der kombinierten Therapiegruppe eine solche Assoziation zeigte. Die Nebenwirkungen und der durchschnittliche Score nach Merle d’Aubigné zeigten keine signifikanten Unterschiede zwischen den drei Gruppen.

Schlussfolgerung:

Die Kombination von Radiotherapie und Indometacin war zur HO-Prävention nach Implantation einer Hüfttotalendoprothese effektiver als alleiniges Indometacin und erfordert weitere Untersuchungen.

Schlüsselwörter:

Heterotope Ossifikationen Hüfttotalendoprothese Radiotherapie Indometacin Kongenitale Hüftdysplasie 

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Copyright information

© Urban &amp; Vogel, Muenchen 2009

Authors and Affiliations

  • Emilios E. Pakos
    • 1
    • 3
    Email author
  • Kosmas S. Stafilas
    • 1
  • Pericles G. Tsekeris
    • 2
  • Aggelos N. Politis
    • 1
  • Gregory Mitsionis
    • 1
  • Theodore A. Xenakis
    • 1
  1. 1.Department of Orthopedic Surgery, University Hospital of IoanninaUniversity of Ioannina, School of MedicineIoanninaGreece
  2. 2.Department of Radiation Therapy, University Hospital of IoanninaUniversity of Ioannina, School of MedicineIoanninaGreece
  3. 3.NeohoropouloIoanninaGreece

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