Celecoxib Prevented Development of Heterotopic Ossification Better Than Ibuprofen After Total Hip Replacement

Abstract

Question: In patients having total hip replacement, is celecoxib as effective as ibuprofen in preventing heterotopic ossification 3 months after surgery? Design: Randomized (allocation concealed), blinded (outcome assessors), controlled trial with 3-month follow-up. Setting: A university hospital in Geneva, Switzerland. Patients: 250 patients (mean age, 70 y; 54% women) with severe osteoarthritis of the hip who were scheduled for total hip replacement. Exclusion criteria were moderate to severe renal impairment, a history of gastrointestinal ulcers, and immediate-type hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors. 240 patients (96%) were available for follow-up. Intervention: Patients were allocated to receive celecoxib, 200 mg twice daily (n = 123), or ibuprofen, 400 mg 3 times daily (n = 127) for 10 days after surgery. All patients had total hip replacement by a direct lateral approach, with an uncemented acetabular component and a cemented femoral stem, and received prophylaxis for deep venous thrombosis with low-molecular-weight heparin for 5 days after surgery and oral anticoagulation for the next 6 weeks. Main outcome measures: Presence ofheterotopic ossification on an anteroposterior radiograph of the pelvis at 3 months. Heterotopic ossification was assessed according to the Brooker classification (class I = islands of bone within soft tissue around the hip; class II = bone spurs from the pelvis or proximal aspect of the femur, leaving ≥1 cm between opposing bone surfaces; class III = bone spurs from the pelvis or proximal aspect of the femur, leaving <1 cm between opposing bone surfaces; and class IV = apparent ankylosis of the hip). Adverse events (renal impairment, electrolyte disorders, and gastrointestinal disturbances) were also assessed. Main results: Analysis was by intention to treat. Celecoxib was more effective than ibuprofen in preventing heterotopic ossification, and fewer celecoxib recipients had Brooker classes II and III heterotopic ossification (Table). Adjustment for age, sex, duration of surgery, and preoperative anti-inflammatory treatment did not alter the results. Conclusion: In patients having total hip replacement through a direct lateral approach, celecoxib was more effective than ibuprofen in preventing heterotopic ossification 3 months after surgery.