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Heterotopic Ossification Rates After Acetabular Fracture Surgery Are Unchanged Without Indomethacin Prophylaxis

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

We previously found no reduction in heterotopic ossification (HO) rates after acetabular surgery with indomethacin compared with a placebo. We subsequently abandoned routine indomethacin therapy after acetabular surgery but questioned whether the incidence had changed using a posterior approach.

Questions/purposes

We therefore determined (1) the incidence of HO after acetabular fracture surgery through a posterior approach; (2) the incidence of symptoms attributable to HO; and (3) the rate of reoperation for HO.

Methods

We retrospectively reviewed the records of all 423 patients with acetabular fractures following our clinical protocol change; of these, 120 were treated with a Kocher-Langenbeck approach and included. The presence of radiographic HO was documented a minimum of 10 weeks postoperatively using the classification of Brooker et al. Symptoms and reoperations were recorded.

Results

The overall incidence of radiographic HO was 47% (56 of 120 patients): 26% Class I–II 13% Class III, and 8% Class IV. Overall, 15% of patients developed symptoms; 3.3% underwent reoperations for excision of HO. There were no major differences between the incidence of moderate and severe HO in this study when compared with the indomethacin and placebo groups from the prior study.

Conclusions

Our incidence of moderate and severe HO has not changed since discontinuing indomethacin. These findings support our institutional decision to abandon routine indomethacin prophylaxis after acetabular surgery. We recommend improved surgical techniques to limit damage to the abductors and improved risk stratification of patients when considering treatment options for HO prophylaxis.

Levels of Evidence

Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Elizabeth Cotton, MS, for her contributions to this project.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, Carolinas Medical Center, 1320 Scott Avenue, Charlotte, NC, 28232, USA

    Sean M. Griffin MD, Stephen H. Sims MD, Madhav A. Karunakar MD, Rachel Seymour PhD & Nikkole Haines MD

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  1. Sean M. Griffin MD
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  2. Stephen H. Sims MD
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  3. Madhav A. Karunakar MD
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  4. Rachel Seymour PhD
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  5. Nikkole Haines MD
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Corresponding author

Correspondence to Sean M. Griffin MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Carolinas Medical Center, Charlotte, NC, USA.

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Griffin, S.M., Sims, S.H., Karunakar, M.A. et al. Heterotopic Ossification Rates After Acetabular Fracture Surgery Are Unchanged Without Indomethacin Prophylaxis. Clin Orthop Relat Res 471, 2776–2782 (2013). https://doi.org/10.1007/s11999-013-2871-4

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  • DOI: https://doi.org/10.1007/s11999-013-2871-4

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