92883
document
Preoperative irradiation versus the use of nonsteroidal anti-inflammatory drugs for prevention of heterotopic ossification following total hip replacement : the results of a randomized trial . PURPOSE Previous studies showed the effectiveness of early preoperative ( 4 h before operation ) irradiation for prevention of heterotopic ossification ( HO ) after total hip replacement . This procedure can result in logistic problems , if there is a great distance between the department of radiotherapy and the orthopedic clinic . To avoid these organizational problems a prospective study was undertaken to analyze the effectiveness of preoperative irradiation on the day preceding surgery ( 16-20 h before operation ) . METHODS AND MATERIALS Between 1995 and 1996 , 100 patients were randomized to receive a prophylactic therapy for prevention of heterotopic ossification . Forty-six patients were irradiated with 7 Gy single dose within 16-20 h before operation . Fifty-four patients were treated with nonsteroidal anti-inflammatory drugs ( NSAID ) ( Voltaren resinat 2 x 75 mg/day for 2 weeks ) . Heterotopic ossification was scored according to the Brooker Grading system . One hundred patients receiving no prophylactic therapy after total hip arthroplasty between 1988 and 1992 were analyzed and defined as the historical control group . RESULTS Incidence of heterotopic ossification was 47.8 % in the 7 Gy preoperative group ( Brooker Score I : 36.9 % ; II : 8.7 % ; III : 2.2 % ; IV : 0 % ) and 11.1 % in the NSAID group ( Brooker Score I : 9.3 % ; II : 1.8 % ; III : 0 % ; IV : 0 % ) . Regarding overall heterotopic ossification there was a significant difference between the NSAID group and the 7 Gy group ( p < 0.01 ) . Analyzing the clinically significant heterotopic ossification ( Brooker Score III and IV ) there was no significant difference between the two treatment arms ( p > 0.05 ) . In the untreated historical control group the incidence of heterotopic ossification was 65 % ( Brooker Score I : 26 % ; II : 15 % ; III : 19 % ; IV : 5 % ) . Referring to overall and to clinically relevant heterotopic ossification the incidence of HO was greater in the control group than in the prophylactically treated groups ( p < 0.05 ) . CONCLUSION Irradiation within 16-20 h before operation and use of NSAID ( Voltaren resinat ) can reduce the incidence of clinically relevant heterotopic ossification after total hip replacement .
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Intervention_Physical
irradiated with 7 Gy single dose within 16-20 h before operation .
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Intervention_Pharmacological
treated with nonsteroidal anti-inflammatory drugs ( NSAID ) ( Voltaren resinat 2 x 75 mg/day for 2 weeks ) .
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Outcome_Physical
heterotopic ossification
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Outcome_Physical
heterotopic ossification
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Outcome_Other
effectiveness of preoperative irradiation
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Outcome_Physical
Heterotopic ossification
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Outcome_Other
Brooker Grading system
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Outcome_Physical
heterotopic ossification
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Outcome_Other
Brooker Score
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Outcome_Other
Brooker Score
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Outcome_Physical
heterotopic ossification
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Outcome_Physical
heterotopic ossification (
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Outcome_Other
Brooker Score III and IV
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Outcome_Physical
)
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Outcome_Physical
heterotopic ossification
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Outcome_Other
Brooker Score
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Outcome_Physical
heterotopic ossification
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Outcome_Physical
HO
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Participant_Condition
total hip replacement
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Participant_Sample-size
100 patients
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Participant_Condition
heterotopic ossification