The suppression of heterotopic ossifications - Radiation versus NSAID therapy - A prospective study

This prospective, randomized study compares the effect of postoperative irr adiation and nonsteroidal anti-inflammatory drug (NSAID) therapy on the pre vention of heterotopic ossifications after the implantation of a total hip endoprosthesis. A total of 154 operations were performed; one group of pati ents underwent radiation treatment of 3 x 3.3 Gy, and the other group took 3 x 50 mg of diclofenac per day over a period of 3 weeks. Average age, sex, preoperative diagnosis, and risk factors were similar in both groups. Post operative radiation began on average 2.9 days after operation, and the radi ation therapy was finished on average within 3.8 days. NSAID prophylaxis wa s begun on the first postoperative day. Heterotopic ossifications occurred in two of the patients who had undergone postoperative prophylaxis by radia tion. In both cases, the ossification was Brooker I, and there was no funct ional impairment. There were no ossifications of Brooker II-IV in this grou p. One patient had a Staphylococcus epidermidis infection, and fistula revi sion had to be carried out; the prosthesis could be left in place. In the g roup treated with NSAID, 16 heterotopic ossifications stage Brooker I and 2 stage Brooker II could be detected. Eleven patients stopped the treatment because of gastrointestinal problems. Both postoperative radiation and NSAI D therapy have proved to be effective prophylactic methods. In direct compa rison, radiation prophylaxis by 3 x 3.3 Gy proved to be slightly more succe ssful than NSAID prophylaxis.