Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: The experience of a combined therapeutic protocol

Abstract

The combination of radiotherapy and indomethacin for the prevention of heterotopic ossification (HO) in high-risk patients undergoing total hip arthroplasty (THA) has not been reported. The aim of this study was to present the experience of our department with this combined therapeutic protocol. Fifty-four patients who underwent THA received a single dose of 7 Gy of postoperative radiotherapy and 75 mg of indomethacin for 15 days. Patients were analysed for clinical and radiographical evidence of HO development at 1 year postoperatively. The overall radiographical incidence of HO was 20.4% (95% CI 10.6-33.5%), while only one patient with clinically significant HO was seen. Patients with secondary arthritis due to congenital hip disease had a statistically significant higher incidence of HO compared with those with osteoarthrosis. Clinical assessment using the Merle d'Aubigné score showed that patients with radiographic evidence of HO had a lower mean score compared with those with no evidence of HO. No treatment-related side effects were seen. Combined radiotherapy and indomethacin was effective in preventing heterotopic ossification after total hip arthroplasty. The evaluation of this efficacy compared with radiotherapy or NSAIDs alone should be the future target of larger randomised studies. © Springer-Verlag 2006.