Indometacin as prophylaxis for heterotopic ossification after the operative treatment of fractures of the acetabulum

• Published in: Journal of bone and joint surgery. British volume Vol. 88; no. 12; pp. 1613 - 1617
• Main Authors: KARUNAKAR, M. A, SEN, A, BOSSE, M. J, SIMS, S. H, GOULET, J. A, KELLAM, J. F
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.12.2006; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Acetabulum - injuries; Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - blood; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Double-Blind Method; Female; Fractures, Bone - surgery; Humans; Indomethacin - blood; Indomethacin - therapeutic use; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Orthopedic surgery; Ossification, Heterotopic - etiology; Ossification, Heterotopic - prevention & control; Patient Compliance; Pharmacology. Drug treatments; Postoperative Complications - prevention & control; Prospective Studies; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Treatment Outcome; Prostaglandin-endoperoxide synthase; Enzyme; Diseases of the osteoarticular system; Indometacin; Enzyme inhibitor; Heterotopic; Acetabulum; Fracture; Trauma; Tocolytic; Ossification; Non steroidal antiinflammatory agent; Prevention; Orthopedic surgery; Treatment; Indoleacetic acid derivatives; Oxidoreductases
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.88B12.18151

Our study was designed to compare the effect of indometacin with that of a placebo in reducing the incidence of heterotopic ossification in a prospective, randomised trial. A total of 121 patients with displaced fractures of the acetabulum treated by operation through a Kocher-Langenbeck approach was randomised to receive either indometacin (75 mg) sustained release, or a placebo once daily for six weeks. The extent of heterotopic ossification was evaluated on plain radiographs three months after operation. Significant ossification of Brooker grade III to IV occurred in nine of 59 patients (15.2%) in the indometacin group and 12 of 62 (19.4%) receiving the placebo. We were unable to demonstrate a statistically significant reduction in the incidence of severe heterotopic ossification with the use of indometacin when compared with a placebo (p = 0.722). Based on these results we cannot recommend the routine use of indometacin for prophylaxis against heterotopic ossification after isolated fractures of the acetabulum.