Caroline Cristofaro, Mohammad Athar, Ellie B Pinsker, Brad Meulenkamp, Timothy R Daniels, Mansur M Halai
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引用次数: 0
Abstract
Background: This study aimed to determine whether prophylactic celecoxib reduces the prevalence of radiographic heterotopic ossification (HO) following total ankle arthroplasty (TAA). Secondary aims included evaluating its effect on the severity of radiographic HO and its association with patient-reported outcome measures (PROMs).
Methods: This retrospective cohort study included all patients who underwent a primary TAA between April 2019 to May 2023 at a single academic institution. The intervention group was composed of patients prescribed 4 weeks of celecoxib postoperatively and was compared to controls who received no celecoxib. Radiographs at ≥8 months were reviewed and graded using the modified Brooker classification for severity of HO. Ankle Osteoarthritis Score pain and disability, 36-Item Short Form Health Survey physical function and mental health were assessed at follow-up.
Results: One hundred seventy-nine patients, 95 males (53.1%) and 84 females (46.9%), were included. The mean age was 65.8 ± 9.6 years. Ninety patients (50.3%) received celecoxib and 89 (49.7%) did not. The prevalence of HO at the time of follow-up (1.2 ± 0.4 years) was 53 (29.6%) with grade 0, 78 (43.6%) with grade 1, 21 (11.7%) with grade 2, 21 (11.7%) with grade 3, and 6 (3.4%) with grade 4. Patients who did not receive celecoxib were significantly more likely to develop HO and experience greater severity of HO, with odds ratios of 2.19 (95% CI 1.10-4.33, P < .05) and 2.51 (95% CI 1.43-4.44, P < .05), respectively. No significant differences in patient-reported outcomes were observed between groups.
Conclusion: Celecoxib for 4 weeks postoperatively may reduce the risk and severity of HO after TAA without affecting patient-reported outcomes. HO prophylaxis did not have a statistically significant impact on PROMs. Celecoxib for HO prophylaxis can be considered following primary TAA while balancing the risks of side effects.Level of Evidence: Level III, (retrospective cohort study).
背景：本研究旨在确定预防性塞来昔布是否能降低全踝关节置换术（TAA）后影像学异位骨化（HO）的发生率。次要目的包括评估其对放射学HO严重程度的影响及其与患者报告的结果测量（PROMs）的关联。方法：本回顾性队列研究纳入了2019年4月至2023年5月在单一学术机构接受原发性TAA的所有患者。干预组由术后服用4周塞来昔布的患者组成，并与未服用塞来昔布的对照组进行比较。回顾≥8个月的x线片，并使用改进的Brooker分级对HO的严重程度进行分级。踝关节骨关节炎评分、疼痛和残疾、36项简短健康调查、身体功能和心理健康评估。结果：共纳入179例患者，其中男性95例（53.1%），女性84例（46.9%）。平均年龄65.8±9.6岁。90例（50.3%）患者接受塞来昔布治疗，89例（49.7%）患者未接受治疗。随访时（1.2±0.4年）HO患病率为0级53例（29.6%），1级78例（43.6%），2级21例（11.7%），3级21例（11.7%），4级6例（3.4%）。未接受塞来昔布治疗的患者发生HO的可能性更大，HO的严重程度也更严重，比值比为2.19 （95% CI 1.10-4.33, P P）。结论：术后4周塞来昔布治疗可以降低TAA后HO的风险和严重程度，而不影响患者报告的结果。HO预防对PROMs没有统计学意义上的显著影响。在平衡副作用风险的同时，可考虑在初次TAA后使用塞来昔布预防HO。证据等级：III级（回顾性队列研究）。
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