Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey

Background In spite of the proven efficacy of pharmacological prophylaxis of heterotopic ossification followingtotal hip arthroplasty, its routine use is still debated, and nodata are available regarding the adherence to its administration in clinical practice.Materials and methods In this prospective, observational,multicenter study, 480 consecutive patients operated on forprimary total hip arthroplasty during the year 2009 werefollowed radiographically for 12 months after surgery inorder to assess the incidence of periprosthetic heterotopicossification. Surgeons were free to choose whether toadminister pharmacological prophylaxis, and were asked tokeep a record of the duration of the prophylaxis (if used) orthe reasons for not using it. To facilitate the statisticalanalysis, all of the participating centers agreed to use onlyone drug (celecoxib) that had already proven to be effective.Results 368 patients were administered celecoxib and112 patients did not receive any prophylaxis. Reportedreasons for not administering celecoxib prophylaxis werethe surgeon’s opinion that prophylaxis was not needed on aroutine basis (84/112 patients, 75%), previous history ofgastrointestinal bleeding (17.8%), and concomitant cardiorenal pathologies (7.1%). The overall incidence of heterotopic ossification in the celecoxib-treated patients was23% (no cases of Brooker grade 3 or 4 ossifications),compared to 55% in the untreated patients (Brooker grade3 and 4: 8.9%). Multivariate analysis showed that celecoxib prophylaxis was the single most important variablewhen predicting the occurrence of heterotopic ossification.Conclusions This study confirms the efficacy and tolerability of celecoxib for the prophylaxis of heterotopicossification after total hip arthroplasty, and shows how thesurgeon’s belief that routine prevention is not required still plays an important role in the determination of this complication, together with the fear of possible unwanted sideeffects