Cristofaro Caroline, Athar Mohammad, Pinsker Ellie B, Meulenkamp Brad, Daniels Timothy R, Halai Mansur M
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada.
Foot Ankle Orthop. 2025 May 29;10(2):24730114251337748. doi: 10.1177/24730114251337748. eCollection 2025 Apr.
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).
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.
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, < .05) and 2.51 (95% CI 1.43-4.44, < .05), respectively. No significant differences in patient-reported outcomes were observed between groups.
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 III, (retrospective cohort study).
本研究旨在确定预防性使用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影像学HO严重程度的影响及其与患者报告结局指标（PROMs）的关联。
这项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初次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。对≥8个月时的X线片进行复查，并使用改良的布鲁克分类法对HO的严重程度进行分级。随访时评估踝关节骨关节炎评分疼痛和残疾情况、36项简短健康调查问卷身体功能和心理健康状况。
共纳入179例患者，其中男性95例（53.1%），女性84例（46.9%）。平均年龄为65.8±9.6岁。90例患者（50.3%）接受了塞来昔布治疗，89例（49.7%）未接受。随访时（1.2±0.4年）HO的发生率为53例（29.6%）为0级，78例（43.6%）为1级，21例（11.7%）为2级，21例（11.7%）为3级，6例（3.4%）为4级。未接受塞来昔布治疗的患者发生HO的可能性显著更高，且HO的严重程度更高，优势比分别为2.19（95%CI 1.10 - 4.33，P <.05）和2.51（95%CI 1.43 - 4.44，P <.05）。两组患者报告的结局之间未观察到显著差异。
术后服用4周塞来昔布可能会降低TAA后HO的风险和严重程度，且不影响患者报告的结局。HO预防对PROMs没有统计学上的显著影响。在初次TAA后，在权衡副作用风险的同时，可以考虑使用塞来昔布预防HO。三级，（回顾性队列研究）。
