Ossifikationsprophylaxe nach Hüft-TEP mit Indomethacin: Analyse von Risikofaktoren

 

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Zusammenfassung

Studienziel: In der internationalen Literatur werden zahlreiche Risikofaktoren für die Entstehung heterotoper Ossifikationen nach Hüftgelenksersatz beschrieben. Diese Risikofaktoren sind dabei ausnahmslos in Kollektiven ohne Ossifikationsprophylaxe evaluiert worden. Ziel dieser prospektiven Untersuchung war daher, die Evaluierung von Risikofaktoren unter Ossifikationsprophylaxe mit Indomethacin. Methode: 211 konsekutive Patienten mit 217 zementfrei implantierten Hüftendoprohthesen wurden prospektiv beobachtet. Die Ossifikationsprophylaxe erfolgte mit Indomethacin über 7 Tage. Die Berechnung der Risikofaktoren wurde durch eine schrittweise ordinale logistische Regression (Kombination aus Vorwärts- und Rückwärtsselektion) durchgeführt. Ergebnisse: Bei 13,5 % der männlichen Patienten wurden Grad 2- bzw. Grad 3-Ossifikationen beobachtet, hingegen nur bei 3,2 % der weiblichen Patienten (p = 0,0043; odds ratio = 0,45). Das Patientenalter hatte ebenfalls einen signifikanten Einfluss (p = 0,0021) auf die Entstehung von Grad 2- und 3-Ossifikationen, wobei mit zunehmenden Alter das Risiko für diese höhergradigen Ossifikationen steigt (odds ratio = 1,03). Patienten mit einer primären Koxarthrose hatten ein signifikant höheres Risiko (p = 0,0307; odds ratio = 0,28), im Vergleich zu Patienten mit einer Hüftdysplasie, Hüftkopfnekrose bzw. rheumathoiden Erkrankung. Schlussfolgerung: Im Vergleich zu den Ergebnissen aus Studien ohne Ossifikationsprophylaxe, bleibt bei einer 7-tägigen Prophylaxe mit Indomethacin unverändert ein erhöhtes Risiko bei männlichen und älteren Individuen sowie bei Patienten mit einer primären Koxarthrose, bestehen. Die Indomethacin-Prophylaxe reduziert lediglich die Inzidenz, nicht das Risiko für die Entstehung ektoper Verkalkungen nach Implantation einer Hüfttotalendoprothese.

Abstract

Aim: Several risk factors are associated with heterotopic bone formation following total hip replacement. All these risk factors were defined in cohorts without any treatment against postoperative ectopic bone. The aim of this prospective study was to reveal risk factors for the development of postoperative ossifications in patients who underwent a 7-day course of indomethacin therapy. Methods: 211 consecutive patients with 217 cementless total hip arthroplasties were included. Patients were given 100 mg indomethacin daily in a 7-day course. Results: Grade 2 or 3 ossifications were observed in 13 (5%) of the male and 3 (2%) of the female Individuals postoperatively (p = 0.0043; odds ratio = 0.45). Older individuals (p = 0.0021; odds ratio = 1.03) as well as patients with primary osteoarthritis (p = 0.0307; odds ratio = 0.28) also showed a higher risk for developing ectopic bone formations. Conclusion: With a 7-day course of indomethacin after total hip arthroplasty, male and elderly individuals, as well as patients with primary osteoarthritis, are considered to be at high risk to develop heterotopic ossifications postoperatively. Indomethacin reduces the incidence of postoperative ectopic ossifications, but not the patient's risk.

Literatur

• 1 Charnley J. The long-term results of low friction arthroplasty of the hip performed as a primary intervention.  J Bone Joint Surg [Br]. 1972;  54 61-76
  PubMedGoogle Scholar
• 2 Rosendahl S, Christoffersen J K, Norgaard M. Paraarticular ossification following hip replacement. 70 arthroplasties ad modum Moore using McFarland's approach.  Acta Orthop Scand. 1977;  48 400-404
  PubMedGoogle Scholar
• 3 Eyb R, Zweymüller K. Periartikuläre Ossifikationen nach Implantation zementfreier Hüfttotalendoprothesen vom Typ Zweymüller-Endler.  Z Orthop. 1985;  123 975-980
  PubMedGoogle Scholar
• 4 Egli S, Woo A. Risk Faktors for heterotopic ossification in total hip arthroplasty.  Arch Orthop Trauma Surg. 2001;  121 531-535
  PubMedGoogle Scholar
• 5 Kjaersgaard-Andersen P, Nafei A, Teichert G, Kristensen O, Schmidt S A, Keller J, Lucht U. Indomethacin for prevention of heterotopic ossification. A randomized controlled study in 41 hip arthroplasties.  Acta Orthop Scand. 1993;  64 639-642
  PubMedGoogle Scholar
• 6 DeLee J, Ferrari A, Charnley J. Ectopic bone formation following low friction arthroplasty of the hip.  Clin Orthop. 1976;  121 53-59
  PubMedGoogle Scholar
• 7 Nollen A J, Slooff T J. Paraarticular ossifications after total hip replacement.  Acta Orthop Scand. 1973;  44 230-241
  PubMedGoogle Scholar
• 8 Jowsey J, Coventry M, Robins P R. Heterotopic Ossification: Theoretical considerations, possible etiological factors, and a clinical review of total hip artrhroplasty patients exhibiting this phenomenon. In: Murray WR (ed). The Hip: Proceedings of the 5th Open Scientific Meeting of the Hip Society. CV Mosby, St. Louis; 177: 201-222
  Google Scholar
• 9 Ritter M A, Vaughn R B. Ectopic ossification after total hip arthroplasty.  J Bone Joint Surg [Am]. 1977;  59 345-351
  PubMedGoogle Scholar
• 10 Schmidt S A, Kjaersgaard-Andersen P, Pedersen N W. 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;  70 834-838
  PubMedGoogle Scholar
• 11 Pagnani M J, Pellicci P M, Salvati E A. Effect of aspirin on heterotopic ossification after total hip arthroplasty in men who have osteoarthritis.  J Bone Joint Surg [Am]. 1991;  73 924-929
  PubMedGoogle Scholar
• 12 Kjaersgaard-Andersen P, Ritter M A. Prevention of formation of heterotopic bone after total hip arthroplasty.  J Bone Joint Surg [Am]. 1991;  73 942-947
  PubMedGoogle Scholar
• 13 Pellegrini V D, Konski A A, Gastel J A, Rubin P, Evarts C M. Prevention of heterotopic ossification with irradiation after total hip arthroplasty. Radiation therapy with a single dose of eight hundred centigray administered to a limited field.  J Bone Joint Surg [Am]. 1992;  74 186-200
  PubMedGoogle Scholar
• 14 Dahl H K. Clinical observations. Symposium on Arthrose. Proceedings of a Conference. October 1974, Norway 1976; 37-46
  Google Scholar
• 15 Wurnig C, Auersperg V, Boehler N. Short term prophylaxis against heterotopic bone after cement less hip replacement.  Clin Orthop. 1997;  334 175-183
  PubMedGoogle Scholar
• 16 Fransen M, Neal B. Non steroidal ant-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty. Cochrane Database Syst Rev 2004; CD001160
  Google Scholar
• 17 Ritter M A, Gioe T J. The effect of indomethacin on pararticular ectopic ossification following total hip arthroplasty.  Clin Orthop. 1982;  167 113-117
  PubMedGoogle Scholar
• 18 Cella J P, Salvati E A, Sculco T P. Indomethacin for the prevention of heterotopic ossification following total hip arthroplasty. Effectiveness, contraindications, and adverse effects.  J Arthroplasty. 1988;  3 229-234
  PubMedGoogle Scholar
• 19 Amstutz H C, Dorey F J. Short-course Indomethacin prevents heterotopic ossfication in a High-risk Population after total hip arthroplasty.  J Arthroplasty. 1997;  12 126-132
  PubMedGoogle Scholar
• 20 McMahon J S, Waddell J P, Morton J. Effect of short course indomethacin on heterotopic bone formation after uncemented total hip arthroplasty.  J Arthroplasty. 1991;  6 259-264
  PubMedGoogle Scholar
• 21 Wurnig C, Schwameis E, Bitzan P, Kainberger F. Six-Year results of a cementless stem with prophylaxis against heterotopic bone.  Clin Orthop. 1999;  361 150-157
  PubMedGoogle Scholar
• 22 Knelles D, Barthel T, Karrer A, Kraus U, Eulert J, Kolbl O. Prevention of heterotopic ossification after total hip replacement. A prospective, randomized study using acetylsalicylic acid, indomethacin and fractional or single-dose irradiation.  J Bone Joint Surg [Br]. 1997;  79 596-602
  PubMedGoogle Scholar
• 23 Ahrengart L, Lindgren U. Heterotopic bone after hip arthroplasty. Defining the patient at risk.  Clin Orthop. 1993;  293 153-159
  PubMedGoogle Scholar
• 24 Riegler H F, Harris C M. Heterotopic bone formation after total hip arthroplasty.  Clin Orthop. 1976;  117 209-216
  PubMedGoogle Scholar
• 25 Cornes P G, Shahidi M, Glees J P. Heterotopic bone formation: irradiation of high-risk patients.  Br J Radiol. 2002;  75 448-452
  PubMedGoogle Scholar
• 26 Arcq M. Ectopic ossification. a complication after total hip replacement.  Arch Orthop Unfallchir. 1973;  77 108-131
  CrossrefPubMedGoogle Scholar
• 27 Kjaersgaard A P, Hougard K, Linde F. Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis.  Orthopedics. 1990;  13 1211-1217
  PubMedGoogle Scholar
• 28 Bundrick T J, Cook D E, Resnik C S. Heterotopic bone formation in patients with DISH following total hip replacement.  Radiology. 1985;  155 595-597
  PubMedGoogle Scholar
• 29 Sundaram N A, Murphy J C. Heterotopic bone formation following total hip arthroplasty in ankylosing spondylitis.  Clin Orthop. 1986;  207 223-226
  PubMedGoogle Scholar
• 30 Bauer R. Operative Approaches to Orthopaedic Surgery and Traumatology. Stuttgart, Thieme Verlag 1987
  Google Scholar
• 31 Zweymüller K A, Lintner F, Semlitsch M. Biologic fixation of a press-fit titanium hip joint endoprosthesis.  Clin Orthop. 1998;  235 195-206
  PubMedGoogle Scholar
• 32 Harris W H. Traumatic arthritis of the hip after dislocation and acetabular fractures treatment by mold arthroplasty. An end result study using a new method of result evaluation.  J Bone Joint Surg [Am]. 1969;  51 737-755
  CrossrefPubMedGoogle Scholar
• 33 Brooker A F, Bowerman J W, Robinson R A, Riley L H. Ectopic ossification following total hip replacement. Incidence and a method of classification.  J Bone Joint Surg [Am]. 1973;  55 1629-1632
  PubMedGoogle Scholar
• 34 Jowsey J, Coventry M B. Heterotopic ossification: Theoretical considerations, possible etiological factors, and a clinical review of total hip arthroplasty patients exhibiting this phenomenon.  Orthop Trans. 1977;  1 69-82
  PubMedGoogle Scholar

H. ZehetgruberMD 

Universitätsklinik für Orthopädie · Medizinuniversität Wien

Währinger Gürtel 18-20

A-1090 Wien

Austria

Phone: (+43)14 04 00-40 83

Fax: (+43)14 04 00-40 29

Email: harald.zehetgruber@meduniwien.ac.at