Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis

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

Research output: Contribution to journalArticle

21 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2776-2782
Number of pages7
JournalClinical Orthopaedics and Related Research
Volume471
Issue number9
DOIs
StatePublished - Jan 1 2013

Fingerprint

Heterotopic Ossification
Indomethacin
Incidence
Reoperation
Placebos
Clinical Protocols
Retrospective Studies
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Griffin, Sean M. ; Sims, Stephen H. ; Karunakar, Madhav A. ; Seymour, Rachel ; Haines, Nikkole. / Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis. In: Clinical Orthopaedics and Related Research. 2013 ; Vol. 471, No. 9. pp. 2776-2782.
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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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Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis. / Griffin, Sean M.; Sims, Stephen H.; Karunakar, Madhav A.; Seymour, Rachel; Haines, Nikkole.

In: Clinical Orthopaedics and Related Research, Vol. 471, No. 9, 01.01.2013, p. 2776-2782.

Research output: Contribution to journalArticle

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