Zusammenfassung
Studienziel: In der internationalen Literatur werden zahlreiche Risikofaktoren für die Entstehung heterotoper Ossifikationen nach Hüftgelenksersatz beschrieben. Diese Risikofaktoren sind dabei ausnahmslos in Kollektiven ohne Ossifikationsprophylaxe evaluiert worden. Ziel dieser prospektiven Untersuchung war daher, die Evaluierung von Risikofaktoren unter Ossifikationsprophylaxe mit Indomethacin. Methode: 211 konsekutive Patienten mit 217 zementfrei implantierten Hüftendoprohthesen wurden prospektiv beobachtet. Die Ossifikationsprophylaxe erfolgte mit Indomethacin über 7 Tage. Die Berechnung der Risikofaktoren wurde durch eine schrittweise ordinale logistische Regression (Kombination aus Vorwärts- und Rückwärtsselektion) durchgeführt. Ergebnisse: Bei 13,5 % der männlichen Patienten wurden Grad 2- bzw. Grad 3-Ossifikationen beobachtet, hingegen nur bei 3,2 % der weiblichen Patienten (p = 0,0043; odds ratio = 0,45). Das Patientenalter hatte ebenfalls einen signifikanten Einfluss (p = 0,0021) auf die Entstehung von Grad 2- und 3-Ossifikationen, wobei mit zunehmenden Alter das Risiko für diese höhergradigen Ossifikationen steigt (odds ratio = 1,03). Patienten mit einer primären Koxarthrose hatten ein signifikant höheres Risiko (p = 0,0307; odds ratio = 0,28), im Vergleich zu Patienten mit einer Hüftdysplasie, Hüftkopfnekrose bzw. rheumathoiden Erkrankung. Schlussfolgerung: Im Vergleich zu den Ergebnissen aus Studien ohne Ossifikationsprophylaxe, bleibt bei einer 7-tägigen Prophylaxe mit Indomethacin unverändert ein erhöhtes Risiko bei männlichen und älteren Individuen sowie bei Patienten mit einer primären Koxarthrose, bestehen. Die Indomethacin-Prophylaxe reduziert lediglich die Inzidenz, nicht das Risiko für die Entstehung ektoper Verkalkungen nach Implantation einer Hüfttotalendoprothese.
Abstract
Aim: Several risk factors are associated with heterotopic bone formation following total hip replacement. All these risk factors were defined in cohorts without any treatment against postoperative ectopic bone. The aim of this prospective study was to reveal risk factors for the development of postoperative ossifications in patients who underwent a 7-day course of indomethacin therapy. Methods: 211 consecutive patients with 217 cementless total hip arthroplasties were included. Patients were given 100 mg indomethacin daily in a 7-day course. Results: Grade 2 or 3 ossifications were observed in 13 (5%) of the male and 3 (2%) of the female Individuals postoperatively (p = 0.0043; odds ratio = 0.45). Older individuals (p = 0.0021; odds ratio = 1.03) as well as patients with primary osteoarthritis (p = 0.0307; odds ratio = 0.28) also showed a higher risk for developing ectopic bone formations. Conclusion: With a 7-day course of indomethacin after total hip arthroplasty, male and elderly individuals, as well as patients with primary osteoarthritis, are considered to be at high risk to develop heterotopic ossifications postoperatively. Indomethacin reduces the incidence of postoperative ectopic ossifications, but not the patient's risk.
Schlüsselwörter
heterotope Ossifikation - Kurzzeitprophylaxe - Risikofaktoren - zementfreie Hüfttotalendoprothese
Key words
indomethacin - heterotopic bone - hip arthroplasty - high risk - short-term - prospective - cementfree
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H. ZehetgruberMD
Universitätsklinik für Orthopädie · Medizinuniversität Wien
Währinger Gürtel 18-20
A-1090 Wien
Austria
Phone: (+43)14 04 00-40 83
Fax: (+43)14 04 00-40 29
Email: harald.zehetgruber@meduniwien.ac.at