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Effects of celecoxib on blood loss, pain, and recovery of function after total knee replacement: A randomized placebo-controlled trial
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
2007 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 5, 661-667 p.Article in journal (Refereed) Published
Abstract [en]

Background: Pain management after surgery has been used as a sales argument for the use of COX-2 inhibitors, but their potential positive and negative effects have not been fully investigated. We thus conducted a controlled evaluation of the effect of celecoxib on perioperative blood loss, pain relief and consumption of analgesics, range of motion, and subjective outcome in conjunction with total knee replacement (TKR).

Method: 50 patients were randomized to either placebo or celecoxib (200 mg) preoperatively and then twice daily. Total blood loss was calculated by the Hb balance method, taking the patient's pre- and postoperative hemoglobin and blood volume into account. Pain scores (VAS), range of motion, and subjective outcome (KOOS) were monitored postoperatively and during the first year after surgery.

Results: No differences in total, hidden, or drainage blood loss were found between the groups. There were 30% lower pain scores during the first 4 weeks after surgery and lower morphine consumption after surgery in the celecoxib group, while no effect was seen on pain, range of motion, and subjective outcome at the 1 year follow-up.

Interpretation: Celecoxib does not increase perioperative blood loss but reduces pain during the postoperative period after TKR. It is not necessary to discontinue celecoxib before surgery. The postoperative use of celecoxib did not increase range of motion or subjective outcome 1 year after TKR.

Place, publisher, year, edition, pages
Taylor & Francis Group , 2007. Vol. 78, no 5, 661-667 p.
Keyword [en]
Not available
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-15109DOI: 10.1080/17453670710014365OAI: oai:DiVA.org:liu-15109DiVA: diva2:54408
Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Cyclooxygenase-2 inhibitors and knee prosthesis surgery
Open this publication in new window or tab >>Cyclooxygenase-2 inhibitors and knee prosthesis surgery
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Adverse effects of cyclooxygenase (COX) inhibitors on bone healing have previously been demonstrated in diaphyseal fracture models in animals. In spite of that, they are widely used as postoperative analgesics in orthopaedic surgery. After joint replacement, a bone repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration and with time loosening.

This thesis investigates the effects of a selective COX-2 inhibitor (parecoxib or celecoxib) on bone healing in metaphyseal bone in a rat model and on knee prosthesis migration after total knee replacement, as measured with radiostereometric analysis. Blood loss, postoperative recovery, and the 2-year subjective outcome, were also measured. In addition, a hemoglobin dilution method for blood loss estimation, used in this thesis, was evaluated.

In the first study, pull-out force of a screw inserted in metaphyseal bone of the tibia in rats was only marginally decreased by parecoxib after 7 days but not after 14 days. In the second and third study, celecoxib treatment resulted in less pain postoperatively in conjunction with total knee replacement (TKR), but no effects were seen on blood loss, range of motion, subjective outcome, or prosthesis migration after 2 years.

Comparing the true blood loss of blood donors with the blood loss estimated by the hemoglobin dilution method, this method was found to underestimate the true blood loss. It is therefore not suitable for calculation of the absolute blood loss volume, but may be used for a rough estimate.

In summary, celecoxib and presumably other cyclooxygenase inhibitors seems not likely to increase the risk of prosthesis loosening.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 48 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1077
Keyword
Non-steroidal anti-inflammatory agents, administration & dosage, Arthroplasty, knee replacement, Surgical blood loss, Surgery, Cyclooxygenase inhibitors, Cyclooxygenase inhibitors, Fracture healing, Isoxazoles, Postoperative pain, Pyrazoles, Sulfonamides
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-15114 (URN)978-91-7393-811-2 (ISBN)
Public defence
2008-09-19, Eken, Hälsouniversitet, ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2009-08-21Bibliographically approved

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Meunier, AndreasLisander, BjörnGood, Lars

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Orthopaedics and Sports Medicine Faculty of Health SciencesDepartment of Orthopaedics LinköpingAnesthesiology
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