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Celecoxib does not appear to affect prosthesis fixation in total knee replacement
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 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 Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
2009 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 80, no 1, 46-50 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose: After joint replacement, a 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. Cox-2 inhibitors are widely used as postoperative analgesics, and have adverse effects on bone healing. This could tamper prosthesis fixation. We investigated if celecoxib, a selective Cox-2 inhibitor, increases prosthesis migration in total knee replacement (TKR).

Methods: 50 patients were randomized to either placebo or celecoxib 200mg twice daily during 3 weeks after TKR (NexGen®, Zimmer). Maximum total point motion (MTPM) of the tibial component was measured after 2 years using radiostereometric analysis (RSA). In addition, range of motion, pain, and, subjective outcome were evaluated.

Results: No differences in prosthesis migration, pain scores, range of motion or subjective outcome were found after 2 years. Confidence intervals were narrow.

Interpretation: Celecoxib is not likely to increase the risk of loosening and may be used safely in conjunction with TKR.

Place, publisher, year, edition, pages
2009. Vol. 80, no 1, 46-50 p.
Keyword [en]
Not available
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-15110DOI: 10.1080/17453670902804976OAI: oai:DiVA.org:liu-15110DiVA: diva2:54409
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, AndreasAspenberg, PerGood, Lars

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