INDOMETHACIN - SHORT-TERM-THERAPY VS. SIN GLE-LOW-DOSE-RADIATION FOR PROPHYLAXIS OF PERIARTICULAR OSSIFICATIONS (PAO) FOLLOWING TOTAL HIP-ARTHROPLASTY

Introduction: With a general incidence of about 40% periarticular ossi fications (PAO) constitute one of the more frequent complications afte r total hip arthroplasty. A prospective, randomized therapy - study in vestigates the prophylactic values of Indomethacin-Short-Term-Therapy and Single-Dose-Radiatio, respectively. Material and Methods: Consecut ive patients for elective, cementless THA were randomized; the Indomet hacin-Group (A, n=31 at the end of the study) was admitted 100 mg Indo methacin/supp. at the day of operation and 3 x 25 mg orally from posto perative day 1 to 10. Other NSAID were not given. The Radiatio-group ( B; n=19) was irradiated by a single dose of 6 Gy within postoperative days 1 to 4; no NSAID were admitted. Follow up tvas at dismissal and a fter 6 (NU 1) and 12 (NU 2) months. Incidence and severity of PAO and the clinical objective and subjective results were registered. Results : Age-and side-distribution as well as the etiologies were comparable in both groups. All patients took part in NU 1 and 90% in NU 2. There were no major differences in the incidence of postoperative PAO in bot h groups. In 68 % (A) and 53 % (B), resp., there were no PAO at dismis sal and after six months, PAO of Brooker Grade I and II were seen in 3 0 (A) and 47% (B), resp., PAO of Grade III and IV - those having gener ally clinical relevance - did not occur at all. These results were con firmed after 12 months. The clinical objective result ameliorated betw een admission and dismissal by an average of 3,5 points and by another 2 points between dismissal and NU 2. Discussion: The results show tha t Indomethacin-Short-Term-Therapy as well as Single-Dose-Radiatio with 6 Gy can reliably prevent the occurence of severe PAO. Both therapeut ic concepts therefore can be employed as prophylaxis in primary endopr osthetic operations. The choice between the two procedures will then m ainly be determined by given logistic conditions in the clinic, specif ic contraindications of the patient and financial considerations.