Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac

Int Orthop. 2016 Apr;40(4):673-80. doi: 10.1007/s00264-015-3077-z. Epub 2016 Jan 4.


Purpose: This study investigated whether etoricoxib (COX-II blocker) has a superior efficacy of preventing heterotopic ossification (HO) after total hip arthroplasty (THA) compared to diclofenac (non-selective NSAID).

Methods: One hundred patients were included (50 in each group) in this single centre, prospective, double-blinded, randomized, controlled trial. Etoricoxib (90 mg) was administered once and diclofenac (75 mg) twice per day for a perioperative period of nine days. The incidence of HO was evaluated on radiographs of the pelvis six months after surgery.

Results: Eighty nine of 100 (89 %) patients could be analysed. The overall HO incidence was 37.8 %. There was no significant difference between both study groups. Twelve patients (27.3 %) of the DIC group and 13 patients (28.9 %) of the ETO group showed Brooker grade I ossifications. Five patients (11.4 %) of the DIC and four patients of the ETO (8.9 %) group showed grade II HO formations. No class III or IV HO formations occured in both groups. Ad hoc analysis detected a negative correlation between HO incidence and limited abduction and internal rotation of the hip.

Conclusions: Etoricoxib and diclofenac are equally effective for oral HO prophylaxis after primary cementless THA when given for nine peri-operative days to ensure a full recovery and high patient satisfaction.

Keywords: Diclofenac; Etoricoxib; Heterotopic ossification; Prophylaxis; Total hip arthroplasty.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Cyclooxygenase 2 Inhibitors / adverse effects
  • Cyclooxygenase 2 Inhibitors / therapeutic use*
  • Diclofenac / adverse effects
  • Diclofenac / therapeutic use*
  • Double-Blind Method
  • Etoricoxib
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Ossification, Heterotopic / etiology
  • Ossification, Heterotopic / prevention & control*
  • Pelvis / diagnostic imaging
  • Pelvis / pathology
  • Perioperative Period
  • Prospective Studies
  • Pyridines / adverse effects
  • Pyridines / therapeutic use*
  • Sulfones / adverse effects
  • Sulfones / therapeutic use*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase 2 Inhibitors
  • Pyridines
  • Sulfones
  • Diclofenac
  • Etoricoxib