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International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 826–830 | Cite as

The efficacy of a multimodal analgesia protocol in preventing heterotopic ossification after acetabular fractures surgery

  • Liang Cheng
  • Hai-Tao Long
  • Bu-Hua Sun
  • Shu-shan Zhao
  • Yong ZhuEmail author
Research Article

Abstract

Background Heterotopic ossification (HO) after joint surgery is always a disturbing problem for patients and surgeons. Prophylaxis is the most effective therapy. Objective To assess the efficacy and safety of a multimodal analgesia protocol that included parecoxib and celecoxib in preventing HO after acetabular fracture surgery. Setting Selecting patients from trauma registry of our hospital. Method We identified 259 patients who had acetabular fracture surgery between January 2008 and December 2014. Hundredsixty-three patients received parecoxib and celecoxib (Group A) and 96 patients received no prophylaxis (Group B). The presence of HO was assessed according to the classification of Brooker et al. at the 12 month postoperative visit. Main outcome measure The differences in HO incidence and severity between the two groups. Results 49 patients (30.0%) developed HO in the Group A and 44(45.8%) in Group B. The difference in total HO incidence between the two groups was significant (P = 0.011 < 0.05, χ2 = 6.530, OR 0.508, 95% CI (0.301–0.857). Severe HO (Brooker grade III or IV) developed in 15 patients (9.2%) in Group A and 17 patients (17.7%) in Group B. Brooker grade I + II was 34(20.9%) and 27(28.1%) in each group. The difference in the severity of HO between the two Groups was significant (P = 0.008 < 0.05). Conclusion A short-term administration of parecoxib and celecoxib aids in the prevention of HO after acetabular fractures surgery.

Keywords

Acetabular fracture COX-2 Heterotopic ossification Multimodal analgesia 

Notes

Acknowledgements

We are grateful to the staff of our medical record information section for providing the patients data.

Funding

This study was supported by the Grants from the Provincial Science Foundation of Hunan (No. 2015SK20474), Natural Science Foundation of Hunan Province (CN) (No. 2017JJ3477) and Xiangya Clinical Big Data Project (xyyydsj9).

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Sinha S, Uchibe K, Usami Y, Pacifici M, Iwamoto M. Effectiveness and mode of action of a combination therapy for heterotopic ossification with a retinoid agonist and an anti-inflammatory agent. Bone. 2016/02/20 edn; 2016.Google Scholar
  2. 2.
    Sun Y, Cai J, Yu S, Chen S, Li F, Fan C. MiR-630 inhibits endothelial-mesenchymal transition by targeting slug in traumatic heterotopic ossification. Sci Rep. 2016;6:22729. doi: 10.1038/srep22729srep22729.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nauth A, Giles E, Potter BK, Nesti LJ, O’Brien FP, Bosse MJ, et al. Heterotopic ossification in orthopaedic trauma. J Orthop Trauma. 2012;26(12):684–8. doi: 10.1097/BOT.0b013e3182724624.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Pavlou G, Kyrkos M, Tsialogiannis E, Korres N, Tsiridis E. Pharmacological treatment of heterotopic ossification following hip surgery: an update. Expert Opin Pharmacother. 2012;13(5):619–22. doi: 10.1517/14656566.2012.662342.CrossRefPubMedGoogle Scholar
  5. 5.
    Grohs JG, Schmidt M, Wanivenhaus A. Selective COX-2 inhibitor versus indomethacin for the prevention of heterotopic ossification after hip replacement: a double-blind randomized trial of 100 patients with 1-year follow-up. Acta Orthop. 2007;78(1):95–8. doi: 10.1080/17453670610013484.CrossRefPubMedGoogle Scholar
  6. 6.
    van der Heide HJ, Koorevaar RT, Schreurs BW, van Kampen A, Lemmens A. Indomethacin for 3 days is not effective as prophylaxis for heterotopic ossification after primary total hip arthroplasty. J Arthroplasty. 1999;14(7):796–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Kan SL, Yang B, Ning GZ, Chen LX, Li YL, Gao SJ, et al. Nonsteroidal anti-inflammatory drugs as prophylaxis for heterotopic ossification after total hip arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94(18):e828.CrossRefGoogle Scholar
  8. 8.
    van der Heide HJ, Rijnberg WJ, Van Sorge A, Van Kampen A, Schreurs BW. Similar effects of rofecoxib and indomethacin on the incidence of heterotopic ossification after hip arthroplasty. Acta Orthop. 2007;78(1):90–4. doi: 10.1080/17453670610013475.CrossRefPubMedGoogle Scholar
  9. 9.
    Sun Y, Cai J, Li F, Liu S, Ruan H, Fan C. The efficacy of celecoxib in preventing heterotopic ossification recurrence after open arthrolysis for post-traumatic elbow stiffness in adults. J Shoulder Elbow Surg. 2015;24(11):1735–40. doi: 10.1016/j.jse.2015.07.006S1058-2746(15)00380-8.CrossRefPubMedGoogle Scholar
  10. 10.
    Schug SA, Joshi GP, Camu F, Pan S, Cheung R. Cardiovascular safety of the cyclooxygenase-2 selective inhibitors parecoxib and valdecoxib in the postoperative setting: an analysis of integrated data. Anesth Analg. 2009;108(1):299–307. doi: 10.1213/ane.0b013e31818ca3ac108/1/299.CrossRefPubMedGoogle Scholar
  11. 11.
    Ittichaikulthol W, Prachanpanich N, Kositchaiwat C, Intapan T. The post-operative analgesic efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty. J Med Assoc Thai. 2010;93(8):937–42.PubMedGoogle Scholar
  12. 12.
    Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. preliminary report. J Bone Joint Surg Am. 1964;46:1615–46.CrossRefPubMedGoogle Scholar
  13. 13.
    Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Ranganathan K, Loder S, Agarwal S, Wong VC, Forsberg J, Davis TA, et al. Heterotopic ossification: basic-science principles and clinical correlates. J Bone Joint Surg Am. 2015;97(13):1101–11. doi: 10.2106/JBJS.N.0105697/13/1101.CrossRefPubMedGoogle Scholar
  15. 15.
    Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22(5):588–93. doi: 10.1097/ACO.0b013e328330373a.CrossRefPubMedGoogle Scholar
  16. 16.
    Moore KD, Goss K, Anglen JO. Indomethacin versus radiation therapy for prophylaxis against heterotopic ossification in acetabular fractures: a randomised, prospective study. J Bone Joint Surg Br. 1998;80(2):259–63.CrossRefPubMedGoogle Scholar
  17. 17.
    Karunakar MA, Sen A, Bosse MJ, Sims SH, Goulet JA, Kellam JF. Indometacin as prophylaxis for heterotopic ossification after the operative treatment of fractures of the acetabulum. J Bone Joint Surg Br. 2006;88(12):1613–7. doi: 10.1302/0301-620X.88B12.18151.CrossRefPubMedGoogle Scholar
  18. 18.
    Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z. 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. doi: 10.1007/s00264-009-0886-y.CrossRefPubMedGoogle Scholar
  19. 19.
    Schmidt M, Lamberts M, Olsen AM, Fosboll E, Niessner A, Tamargo J, et al. Cardiovascular safety of non-aspirin non-steroidal anti-inflammatory drugs: review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother. 2016;2(2):108–18. doi: 10.1093/ehjcvp/pvv054pvv054.CrossRefPubMedGoogle Scholar
  20. 20.
    Liu SS, Bae JJ, Bieltz M, Ma Y, Memtsoudis S. Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement. Reg Anesth Pain Med. 2012;37(1):45–50. doi: 10.1097/AAP.0b013e31823354f5.CrossRefPubMedGoogle Scholar
  21. 21.
    Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;151:81–106.Google Scholar
  22. 22.
    Burd TA, Lowry KJ, Anglen JO. Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures. J Bone Joint Surg Am. 2001;83-A(12):1783–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Blokhuis TJ, Frolke JP. Is radiation superior to indomethacin to prevent heterotopic ossification in acetabular fractures? A systematic review. Clin Orthop Relat Res. 2009;467(2):526–30. doi: 10.1007/s11999-008-0532-9.CrossRefPubMedGoogle Scholar
  24. 24.
    Bek D, Beksac B, Della Valle AG, Sculco TP, Salvati EA. Aspirin decreases the prevalence and severity of heterotopic ossification after 1-stage bilateral total hip arthroplasty for osteoarthrosis. J Arthroplasty. 2009;24(2):226–32. doi: 10.1016/j.arth.2007.11.008S0883-5403(07)00647-X.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Department of Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina

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