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Rofecoxib inhibits heterotopic ossification after total hip arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs) prevent heterotopic ossification but gastrointestinal complaints are frequently. Selective cyclooxygenase-2 (COX-2) inhibiting NSAID produce less gastrointestinal side effects.

Patients and methods

A prospective two-stage study design for phase 2 clinical trials with 42 patients was used to determine if rofecoxib (a COX-2 inhibitor) 50 mg oral for 7 days prevents heterotopic ossification. A cemented primary THA was inserted for osteoarthroses. After 6 months heterotopic bone formation was assessed on AP radiographs using the Brooker classification.

Results

No heterotopic ossification was found in 81% of the patients, 19% of the patients had Brooker grade 1 ossification.

Conclusion

Using a two-stage study design for phase 2 clinical trials, a 7-day treatment of a COX-2 inhibitor (rofecoxib) prevents effectively the formation of heterotopic ossification after cemented primary total hip arthroplasty.

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References

  1. Neal BC, Rodgers A, Clark T et al (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 71:122–128

    Article  PubMed  CAS  Google Scholar 

  2. Dorn U, Grethen C, Effenberger H, Berka H, Ramsauer T, Drekonja T (1998) Indomethacin for prevention of heterotopic ossification after hip arthroplasty. A randomized comparison between 4 and 8 days of treatment. Acta Orthop Scand 69:107–110

    PubMed  CAS  Google Scholar 

  3. Gebuhr P, Soelberg M, Orsnes T, Wilbek H (1991) Naproxen prevention of heterotopic ossification after hip arthroplasty. A prospective control study of 55 patients. Acta Orthop Scand 62:226–229

    PubMed  CAS  Google Scholar 

  4. Kjaersgaard-Andersen P, Schmidt SA (1986) Indomethacin for prevention of ectopic ossification after hip arthroplasty. Acta Orthop Scand 57:12–14

    PubMed  CAS  Google Scholar 

  5. Knelles D, Barthel T, Karrer A, Kraus U, Eulert J, Kolbl O (1997) Prevention of heterotopic ossification after total hip replacement. A prospective, randomised study using acetylsalicylic acid, indomethacin and fractional or single-dose irradiation. J Bone Joint Surg Br 79:596–602

    Article  PubMed  CAS  Google Scholar 

  6. Wurnig C, Auersperg V, Boehler N et al (1997) Short term prophylaxis against heterotopic bone after cementless hip replacement. Clin Orthop 334:175–183

    PubMed  Google Scholar 

  7. 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 3:229–234

    PubMed  CAS  Google Scholar 

  8. Bombardier C, Laine L, Reicin A et al (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 343:1520–1528, 2 p

    Google Scholar 

  9. Silverstein FE, Faich G, Goldstein JL et al (2000) Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 284:1247–1255

    Article  PubMed  CAS  Google Scholar 

  10. Simon R (1989) Optimal two stage designs for phase ll clinical trials. Control Clin Trials 10:1–10

    Article  PubMed  CAS  Google Scholar 

  11. 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 14:796–799

    Article  PubMed  Google Scholar 

  12. 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

    PubMed  CAS  Google Scholar 

  13. Barthel T, Baumann B, Noth U, Eulert J (2002) Prophylaxis of heterotopic ossification after total hip arthroplasty: a prospective randomized study comparing indomethacin and meloxicam. Acta Orthop Scand 73:611–614

    Article  PubMed  Google Scholar 

  14. Legenstein R, Bosch P, Ungersbock A (2003) Indomethacin versus meloxicam for prevention of heterotopic ossification after total hip arthroplasty. Arch Orthop Trauma Surg 123:91–94

    PubMed  Google Scholar 

  15. van der Heide HJ, Spruit M, Slappendel R, Klooster N, van Limbeek J (2004) Prophylaxis for heterotopic ossification after primary total hip arthroplasty. A cohort study between indomethacin and meloxicam. Acta Orthop Belg 70:240–246

    PubMed  Google Scholar 

  16. Romano CL, Duci D, Romano D, Mazza M, Meani E (2004) Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty. J Arthroplasty 19:14–18

    Article  PubMed  Google Scholar 

  17. Banovac K, Williams JM, Patrick LD, Levi A (2004) Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib). Spinal Cord 42:707–710

    Article  PubMed  CAS  Google Scholar 

  18. Feldman M, McMahon AT (2000) Do cyclooxygenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflammatory drugs, with less gastrointestinal toxicity? Ann Intern Med 132:134–143

    PubMed  CAS  Google Scholar 

  19. Laine L (2002) The gastrointestinal effects of nonselective NSAIDs and COX-2-selective inhibitors. Semin Arthritis Rheum 32:25–32

    Article  PubMed  CAS  Google Scholar 

  20. Weber EWG, Slappendel R, Durieux ME, Dirksen R, van der Heide HJ, 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 Anaesthesiologie 20:963–966

    Article  CAS  Google Scholar 

  21. Ro J, Sudmann E, Marton PF (1976) Effect of indomethacin on fracture healing in rats. Acta Orthop Scand 47:588–599

    Article  Google Scholar 

  22. Goodman S, Ma T, Trindade M et al (2002) COX-2 selective NSAID decreases bone ingrowth in vivo. J Orthop Res 20:1164–1169

    Article  PubMed  CAS  Google Scholar 

  23. Goodman SB, Ma T, Genovese M, Lane SR (2003) COX-2 selective inhibitors and bone. Int J Immunopathol Pharmacol 16:201–205

    PubMed  CAS  Google Scholar 

  24. Harder AT, An YH (2003) The mechanisms of the inhibitory effects of nonsteroidal anti-inflammatory drugs on bone healing: a concise review. J Clin Pharmacol 43:807–815

    Article  PubMed  CAS  Google Scholar 

  25. Aspenberg P (2005) Drugs and fracture repair. Acta Orthop 76:741–748

    Article  PubMed  Google Scholar 

  26. Aspenberg P (2005) Postoperative Cox inhibitors and late prosthetic loosening–suspicion increases! Acta Orthop 76:733–734

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics 800, Radboud University Medical Center, P.O. Box 9100, 6500 HB, Nijmegen, The Netherlands

    Huub J. L. van der Heide, Rinco C. T. Koorevaar, Albert van Kampen & B. Willem Schreurs

  2. Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands

    J. Albert M. Lemmens

Authors
  1. Huub J. L. van der Heide
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  2. Rinco C. T. Koorevaar
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  3. J. Albert M. Lemmens
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  4. Albert van Kampen
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  5. B. Willem Schreurs
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Corresponding author

Correspondence to B. Willem Schreurs.

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van der Heide, H.J.L., Koorevaar, R.C.T., Lemmens, J.A.M. et al. Rofecoxib inhibits heterotopic ossification after total hip arthroplasty. Arch Orthop Trauma Surg 127, 557–561 (2007). https://doi.org/10.1007/s00402-006-0243-1

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  • DOI: https://doi.org/10.1007/s00402-006-0243-1

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