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Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac

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Abstract

Purpose

This study investigated whether etoricoxib (COX-II blocker) has a superior efficacy of preventing heterotopic ossification (HO) after total hip arthroplasty (THA) compared to diclofenac (non-selective NSAID).

Methods

One hundred patients were included (50 in each group) in this single centre, prospective, double-blinded, randomized, controlled trial. Etoricoxib (90 mg) was administered once and diclofenac (75 mg) twice per day for a perioperative period of nine days. The incidence of HO was evaluated on radiographs of the pelvis six months after surgery.

Results

Eighty nine of 100 (89 %) patients could be analysed. The overall HO incidence was 37.8 %. There was no significant difference between both study groups. Twelve patients (27.3 %) of the DIC group and 13 patients (28.9 %) of the ETO group showed Brooker grade I ossifications. Five patients (11.4 %) of the DIC and four patients of the ETO (8.9 %) group showed grade II HO formations. No class III or IV HO formations occured in both groups. Ad hoc analysis detected a negative correlation between HO incidence and limited abduction and internal rotation of the hip.

Conclusions

Etoricoxib and diclofenac are equally effective for oral HO prophylaxis after primary cementless THA when given for nine peri-operative days to ensure a full recovery and high patient satisfaction.

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Acknowledgments

The excellent help of the following is highly appreciated:

Karoline Fischer, Ferdinand Wagner M.D., Franz-Xaver Köck M.D., Eva-Maria Bauser M.D., Christoph Schröter M.D., Jochen Wolfsteiner M.D., Jens Schaumburger M.D., Guido Heers M.D.

Department of Orthopaedic Surgery (Regensburg University Medical Centre, Bad Abbach, Germany).

We thank Taylor & Francis Ltd. (www.tandfonline.com) for granting us permission to reproduce parts of our material in this publication.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany

    Sebastian Winkler, Hans-Robert Springorum, Tobias Vaitl, Martin Handel, Benjamin Craiovan & Joachim Grifka

  2. Münchner Studienzentrum, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany

    Sabine Barta

  3. Institute for Medical Statistics and Epidemiology, Technische Universität, Munich, Germany

    Victoria Kehl

Authors
  1. Sebastian Winkler
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  2. Hans-Robert Springorum
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  3. Tobias Vaitl
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Corresponding author

Correspondence to Sebastian Winkler.

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Competing interests

J.G. reports connections to Springer International outside the submitted work. S.W. has received grants from the Medical faculty of the University of Regensburg outside the submitted work. HRS, TV, MH, SB, VK and BC report no competing interests.

Funding

This study was an investigator initiated trial (IIT) and funded by MSD Sharp & Dohme, Germany. The sponsor did not contribute to the preparation of this article.

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Winkler, S., Springorum, HR., Vaitl, T. et al. Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac. International Orthopaedics (SICOT) 40, 673–680 (2016). https://doi.org/10.1007/s00264-015-3077-z

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