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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2011 August;62(4):253-61
Prophylaxis of heterotopic ossification after hip surgery: our experience with celecoxib and review of literature
Cicirello M., Colombero D., Aprato A., Capella M., Governale G., Massè A.
Department of Orthopedics, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
Heterotopic ossification (HO) is a well-known complication in hip surgery; the reported incidence ranges from 0.6% to 90% after total hip arthroplasty (THA) and from 18% to 90% after internal fixation of acetabular fractures. The pathophysiology of this condition would appear to be related to a combination of systemic and local factors, including soft-tissue damage and over-expression of bone morphogenetic proteins. Although the routine use of HO prophylaxis in THA and internal fixation of acetabular fractures is not vigorously recommended, prophylaxis is nowadays mandatory for high-risk patients. Indomethacin and radiation therapy have been currently used for HO prevention; nevertheless they showed various limitations. Recent studies demonstrated that selective COX-2 inhibition may be sufficient for the prevention of HO, with a consequent increasing interest in celecoxib employment. We prospectively studied the effect of celecoxib on the development of HO after total hip arthroplasty or internal fixation of acetabular fractures in 32 patients; according to the literature, we found an incidence of HO about 16% after THA and 11% after acetabular fractures, with a low-rate of side effects (3% of cases). In conclusion, Celecoxib seems to be a promising option for the future in the routine prophylaxis of heterotopic hossification with favorable results in terms of efficacy and safety profile compared with the commonly used NSAIDs indomethacin.