Summary
A double-blind prospective parallel group study comparing slow-release flurbiprofen with placebo in the control of ectopic bone formation was carried out in 68 patients undergoing total hip arthroplasty. Eight weeks after surgery there was evidence, significant at the 1% level, that the incidence and extent of periarticular calcification was lower in the flurbiprofen group. At an early phase, serum calcium level decreased and after 8 weeks serum alkaline phosphatase level increased more in the placebo group than in the flurbiprofen group, indicating an effect of flurbiprofen on bone mineral metabolism. Six patients were withdrawn in each treatment group, four due to side effects in the flurbiprofen group and three due to side effects in the placebo group. Overall, five patients in each group reported side effects, the nature and severity of the side effects being very similar in each group. We conclude that flurbiprofen is an efficient and safe drug in limiting ectopic bone formation following total hip arthroplasty. Heterotopic bone formation is a frequent complication after total hip replacement [1, 2, 4–6, 8–16]. Heterotopic bone reduces the extent of hip motion, reduction being more evident in cases with extensive ectopic bone formation around the hip joint [3, 10, 11]. Various treatment regimens have been proposed for discouraging heterotopic bone formation. Anti-inflammatory agents such as indomethacin and ibuprofen have turned out effective [11, 12, 14]. Local irradiation also prevents ectopic bone formation [4], but diphosphonates seem not be effective in this respect [15]. The aim of the present study was to assess the efficacy of flurbiprofen, a new anti-inflammatory agent, in limiting heterotopic bone formation, and to note the frequency and severity of any side effects of the treatment.
Similar content being viewed by others
References
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] 55:1629–1632
Bisla RS, Ranawat CS, Inglis AE (1976) Total hip replacement with ancylosing spondylitis with involvement of the hip. J Bone Joint Surg [Am] 58:233–238
Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg [Br] 54:61–76
Coventry MB, Scanlon PW (1981) The use of radiation to discourage ectopic bone. J Bone Joint Surg [Am] 63:201–208
DeLee J, Ferrari A, Charnley J (1976) Ectopic bone formation following low-friction arthroplasty of the hip. Clin Orthop 121:53–59
Elmstedt E, Lindholm TS, Nilsson OS, Tornkvist H (1985) Effect of ibuprofen on heterotopic ossification after hip replacement. Acta Orthop Scand 56:25–27
Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg [Br] 64:17–19
Hierton C, Blomgren G, Lindgren U (1983) Factors associated with heterotopic bone formation in cemented total hip prostheses. Acta Orthop Scand 54:698–702
Morrey BF, Adams RA, Cabanela ME (1984) Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Clin Orthop 188:160–167
Ritter MA, Vaughan RB (1977) Ectopic ossification after total hip arthroplasty. Predisposing factors, frequency, and effects on results. J Bone Joint Surg [Am] 59:345–351
Ritter MA, Gioe TJ (1982) The effect of indomethacin on para-articular ectopic ossification following total hip arthroplasty. Clin Orthop 167:113–117
Ritter MA, Sieber J (1985) Prophylactic indomethacin for the prevention of heterotopic bone formation following total hip arthroplasty. Clin Orthop 196:217–225
Rosendahl S, Krogh Christoffersen J, Nordgaard M (1977) Para-articular ossification following hip replacement. Acta Orthop Scand 48:400–404
Sodemann B, Persson P-E, Nilsson OS (1988) Prevention of periarticular heterotopic ossification following total hip arthroplasty. Clinical experience with indomethacin and ibuprofen. Arch Orthop Trauma Surg 107:329–333
Thomas BJ, Amstutz HC (1985) Results of administration of diphosphonate for prevention of heterotopic ossification after total hip arthroplasty. J Bone Joint Surg [Am] 67:400–403
Wilson PD, Amstutz HC, Czerniecki A, Salvati EA, Mendes DG (1972) Total hip replacement with fixation by acrylic cement. J Bone Joint Surg [Am] 54:207–235
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hoikka, V., Lindholm, T.S. & Eskola, A. Flurbiprofen inhibits heterotopic bone formation in total hip arthroplasty. Arch Orthop Trauma Surg 109, 224–226 (1990). https://doi.org/10.1007/BF00453146
Issue Date:
DOI: https://doi.org/10.1007/BF00453146