Meloxicam versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2013.39.002

Abstract

Abstract:

BACKGROUND: In order to avoid heterotopic ossification after total hip arthroplasty, nonsteroidal anti-inflammatory drugs are commonly used for prevention.
OBJECTIVE: To compare the effect of meloxicam and indomethacin in the prevention of heterotopic ossification after total hip arthroplasty.
METHODS: Fifty-one patients who treated in the Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from 2010 to 2011 were collected. Among the
51 patients, nine patients were treated with bilateral total hip arthroplasty, and all the patients had total hip arthroplasty with the posterior-lateral approach. The patients were divided into the control group and the experimental group according to the drugs used after replacement, and the patients in the two groups were administered with indomethacin sustained-release tablet 25 mg + omeprazole capsule 20 mg or meloxicam tablet 15 mg after replacement.
RESULTS AND CONCLUSION: There were no significant differences in the incidence of heterotopic ossification, pain, modified D’Aubigne and Postel scores after replacement between two groups (P > 0.05). But, the gastrointestinal adverse reactions of the experimental group were less than those of the control group. The application of meloxicam only can effectively avoid the heterotopic ossification and release pain. Consequently, we recommend meloxicam as postoperative drug for the prevention of heterotopic ossification and pain remission following total hip arthroplasty.

Key words: arthroplasty, replacement, hip, prosthesis implantation, anti-inflammatory agents, non-steroidal, ossification, heterotopic

CLC Number:

R318

Figures/Tables 5

References

[1]Riegler HF, Harris CM. Heterotopic bone formation after total hip arthroplasty. Clin Orthop Relat Res. 1976;(117):209-216.
[2]Regis D, Sandri A, Sambugaro E. Incidence of heterotopic ossification after surface and conventional total hip arthroplasty: A comparative study using anterolateral approach and indomethacin prophylaxis. Biomed Res Int. 2013;2013:293528.
[3]Pavlou G, Salhab M, Murugesan L, et al. Risk factors for heterotopic ossification in primary total hip arthroplasty. Hip Int. 2012;22(1):50-55.
[4]Cohn RM, Schwarzkopf R, Jaffe F. Heterotopic ossification after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2011;40(11):E232-235.
[5]Kwapisz A, Koz?owski P, Szemraj J, et al. Correlations between BMP-4 gene expression, heterotopic ossification and function after uncemented total hip replacement. Ortop Traumatol Rehabil. 2013;15(2):117-124.
[6]Fang Z, Sun T, Yadav SK. Research progress of bone morphogenetic protein and liability of ossification of posterior longitudinal ligament. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012;26(10):1255-1258.
[7]Katagiri T. BMP signaling and bone formation. Clin Calcium. 2012;22(11):1677-1683.
[8]Medici D, Olsen BR. The role of endothelial-mesenchymal transition in heterotopic ossification. J Bone Miner Res. 2012; 27(8):1619-1622.
[9]Pakos EE, Pitouli EJ, Tsekeris PG, et al. Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol. Int Orthop. 2006;30(2):79-83.
[10]Cella JP, Salvati EA, Sculco TP. Indomethacin for the prevention of heterotopic ossification following total hip arthroplasty. Effectiveness, contraindications, and adverse effects. J Arthroplasty. 1988;3(3):229-234.
[11]Schmidt SA, Kjaersgaard-Andersen P, Pedersen NW, et al. The use of indomethacin to prevent the formation of heterotopic bone after total hip replacement. A randomized, double-blind clinical trial. J Bone Joint Surg Am. 1988; 70(6): 834-838.
[12]Vasileiadis GI, Sioutis IC, Mavrogenis AF, et al. COX-2 inhibitors for the prevention of heterotopic ossification after THA. Orthopedics. 2011;34(6):467.
[13]Hoff P, Rakow A, Gaber T, et al. Preoperative irradiation for the prevention of heterotopic ossification induces local inflammation in humans. Bone. 2013;55(1):93-101.
[14]Pakos EE, Tsekeris PG, Paschos NK, et al. The role of radiation dose in a combined therapeutic protocol for the prevention of heterotopic ossification after total hip replacement. J BUON. 2010;15(1):74-78.
[15]Cipriano C, Pill SG, Rosenstock J, et al. Radiation therapy for preventing recurrence of neurogenic heterotopic ossification. Orthopedics. 2009;32(9).
[16]Fransen M, Neal B. Withdrawn: Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty. Cochrane Database Syst Rev. 2013;3:CD001160.
[17]Aspenberg P. Avoid cox inhibitors after skeletal surgery! Acta Orthop Scand. 2002;73(5):489-490.
[18]Tsailas PG, Babis GC, Nikolopoulos K, et al. The effectiveness of two COX-2 inhibitors in the prophylaxis against heterotopic new bone formation: an experimental study in rabbits. J Surg Res. 2009;151(1):108-114.
[19]van der Heide HJ, Spruit M, Slappendel R, et al. Prophylaxis for heterotopic ossification after primary total hip arthroplasty. A cohort study between indomethacin and meloxicam. Acta Orthop Belg. 2004;70(3):240-246.
[20]Legenstein R, Bösch P, Ungersböck A. Indomethacin versus meloxicam for prevention of heterotopic ossification after total hip arthroplasty. Arch Orthop Trauma Surg. 2003; 123(2-3):91-94.
[21]Barthel T, Baumann B, Nöth U, et al. Prophylaxis of heterotopic ossification after total hip arthroplasty: a prospective randomized study comparing indomethacin and meloxicam. Acta Orthop Scand. 2002;73(6):611-614.
[22]Dahners LE, Mullis BH. Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue healing. J Am Acad Orthop Surg. 2004;12(3): 139-143.
[23]Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8): 1629-1632.
[24]D'aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36-A(3):451-475.
[25]Kocic M, Lazovic M, Mitkovic M, et al. Clinical significance of the heterotopic ossification after total hip arthroplasty. Orthopedics. 2010;33(1):16.
[26]Pohl F, Seufert J, Tauscher A, et al. The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty. Strahlenther Onkol. 2005; 181(8):529-533.
[27]Chalmers J, Gray DH, Rush J. Observations on the induction of bone in soft tissues. J Bone Joint Surg Br. 1975;57(1):36-45.
[28]Scharstuhl A, Glansbeek HL, van Beuningen HM, et al. Inhibition of endogenous TGF-beta during experimental osteoarthritis prevents osteophyte formation and impairs cartilage repair. J Immunol. 2002;169(1):507-514.
[29]Chauveau C, Devedjian JC, Blary MC, et al. Gene expression in human osteoblastic cells from normal and heterotopic ossification. Exp Mol Pathol. 2004;76(1):37-43.
[30]Pavlou G, Salhab M, Murugesan L, et al. Risk factors for heterotopic ossification in primary total hip arthroplasty. Hip Int. 2012;22(1):50-55.
[31]Okano K, Aoyagi K, Osaki M, et al. Bone mineral density is not related to heterotopic ossification after total hip arthroplasty. Int Orthop. 2012;36(6):1163-1166.
[32]Schwarzkopf R, Cohn RM, Skoda EC, et al. The predictive power of preoperative hip range of motion for the development of heterotopic ossification. Orthopedics. 2011;34(3):169.
[33]Spinarelli A, Patella V, Petrera M, et al. Heterotopic ossification after total hip arthroplasty: our experience. Musculoskelet Surg. 2011;95(1):1-5.
[34]Metzner G, Lindner B, Neumann D, et al. Incidence of anterior intertrochanteric ossifications after total hip arthroplasty—a retrospective long-term follow-up study. Z Orthop Unfall. 2010;148(2):174-179.
[35]Gordon A, Southam L, Loughlin J, et al. Variation in the secreted frizzled-related protein-3 gene and risk of osteolysis and heterotopic ossification after total hip arthroplasty. J Orthop Res. 2007;25(12):1665-1670.
[36]Nayak KN, Mulliken B, Rorabeck CH, et al. Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial. Can J Surg. 1997;40(5):368-374.
[37]Huang WM, Yu XC, Fu ZH, et al. Comparison of incidence of heterotopic ossification in combination versus biotype total hip arthroplasty. Zhongguo Gu yu Guanjie Sunshang Zazhi. 2011;26(10):875-877.
[38]Xue D, Zheng Q, Li H, et al. 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. 2011;35(1):3-8.
[39]Vavken P, Castellani L, Sculco TP. Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis. Clin Orthop Relat Res. 2009;467(12):3283-3289.
[40]van der Heide HJ, Koorevaar RT, Schreurs BW, et al. Indomethacin for 3 days is not effective as prophylaxis for heterotopic ossification after primary total hip arthroplasty. J Arthroplasty. 1999;14(7):796-799.
[41]Bremen-Kühne R, Stock D, Franke C. Indomethacin—short-term therapy vs. single low dosage radiation for prevention of periarticular ossifications after total hip endoprosthesis. Z Orthop Ihre Grenzgeb. 1997;135(5): 422-429.
[42]Fijn R, Koorevaar RT, Brouwers JR. Prevention of heterotopic ossification after total hip replacement with NSAIDs. Pharm World Sci. 2003;25(4):138-145.
[43]Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med. 2000;343(21):1520-1528.
[44]Romanò CL, Duci D, Romanò D, et al. Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty. J Arthroplasty. 2004;19(1):14-18.
[45]Pairet M, van Ryn J, Schierok H, et al. Differential inhibition of cyclooxygenases-1 and -2 by meloxicam and its 4'-isomer. Inflamm Res. 1998;47(6):270-276.
[46]Barthel T, Baumann B, Nöth U, et al. Prophylaxis of heterotopic ossification after total hip arthroplasty: a prospective randomized study comparing indomethacin and meloxicam. Acta Orthop Scand. 2002;73(6):611-614.
[47]Persson PE, Nilsson OS, Berggren AM. Do non-steroidal anti-inflammatory drugs cause endoprosthetic loosening? A 10-year follow-up of a randomized trial on ibuprofen for prevention of heterotopic ossification after hip arthroplasty. Acta Orthop. 2005;76(6):735-740.
[48]Gibbons JJ, Lennon RL, Rose SH, et al. Axillary block of the brachial plexus: "you can't get there from here...". Anesthesiology. 1988;68(2):314-315.