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Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol

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Abstract

The combination of radiotherapy and indomethacin for the prevention of heterotopic ossification (HO) in high-risk patients undergoing total hip arthroplasty (THA) has not been reported. The aim of the present study was to present the experience of our department with this combined therapeutic protocol. Fifty-four patients who underwent THA received a single dose of 7 Gy of postoperative radiotherapy and 75 mg of indomethacin for 15 days. Patients were analyzed for clinical and radiographical evidence of HO development at 1 year postoperatively. The overall radiographical incidence of HO was 20.4% (95% CI 10.6–33.5%), while only 1 patient with clinically significant HO was seen. Patients with secondary arthritis due to congenital hip disease had a statistically significantly higher incidence of HO compared with those with osteoarthrosis. The clinical assessment with the Merle d’Aubigné score showed that patients with radiographic documentation of HO had a lower mean score compared with those with no evidence of HO. No treatment-related side effects were seen. Combined radiotherapy and indomethacin was effective in preventing heterotopic ossification after total hip arthroplasty. The evaluation of this efficacy compared with radiotherapy or NSAIDs alone should be the future target of larger randomized designs.

Résumé

L’association de radiothérapie et d’indométhacine pour la prévention des ossifications hétérotypiques (HO), chez les patients à haut risque, devant bénéficier d’une prothèse totale de hanche (THA) n’a jamais été rapportée. Le but de cette étude est de présenter cette expérience. Cinquante-quatre patients devant bénéficier d’une prothèse totale de hanche ont reçu une dose unique de 7 Gy en post-opératoire de radiothérapie et 75 mg d’indométhacine pendant 15 jours. Sept séries de patients ont été analysés cliniquement, radiographiquement à la recherche d’ossifications hétérotypiques au décours de la première année post-opératoire. L’incidence totale des ossifications hétérotypiques a été de 20,4% (95% CI 10.6–33.5%), un seul patient présentant une ossification gênante sur le plan clinique. Les patients présentant une coxarthrose secondaire à une luxation congénitale de hanche ont, significativement plus d’ossifications hétérotypiques que les patients présentant une coxarthrose banale. Le score de Merle d’Aubigné est significativement plus bas chez les patients présentant des ossifications hétérotypiques avec symptomatologie clinique en comparaison de ceux ne présentant que des signes radiographiques. Il n’y a aucune complication due au traitement. La combinaison radiothérapie indométhacine semble effective dans la prévention des ossifications hétérotypiques après prothèse totale de hanche. L’évaluation de son efficacité en comparaison à une radiothérapie ou à un traitement anti-inflammatoire isolé doit faire l’objet d’une plus longue étude randomisée.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece

    Emilios E. Pakos, Kosmas Stafilas & Theodore H. Xenakis

  2. Department of Radiation Therapy, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece

    Evita J. Pitouli, Pericles G. Tsekeris & Vasiliki Papathanasopoulou

Authors
  1. Emilios E. Pakos
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  2. Evita J. Pitouli
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  3. Pericles G. Tsekeris
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  4. Vasiliki Papathanasopoulou
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  5. Kosmas Stafilas
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  6. Theodore H. Xenakis
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Correspondence to Emilios E. Pakos.

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Pakos, E.E., Pitouli, E.J., Tsekeris, P.G. et al. Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol. International Orthopaedics (SICO 30, 79–83 (2006). https://doi.org/10.1007/s00264-005-0054-y

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  • DOI: https://doi.org/10.1007/s00264-005-0054-y

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