The effect of post-operative NSAID administration on bone healing after elective foot and ankle surgery

Foot Ankle Surg. 2020 Jun;26(4):457-463. doi: 10.1016/j.fas.2019.05.016. Epub 2019 May 31.

Abstract

Background: Post-operative pain is a common concern following elective foot and ankle surgery. NSAIDs used for pain relief have led to bone-healing complications in animal models and in vitro studies. This retrospective study examined the rate of bone-healing complications in post-surgical patients using NSAIDs.

Methods: Participants underwent elective foot surgeries between January 2016 and May 2018. Radiographs were used to identify bony nonunion at osteotomy sites 12 weeks post-surgery.

Results: Two-hundred thirty-two patients were evaluated; 59 (25.43%) were prescribed ibuprofen, 62 (27%) ketorolac, 15 (6.47%) acetaminophen, and 92 (40%) hydrocodone-acetaminophen. Two-hundred and twelve (91.38%) patients exhibited radiographic evidence of osseous union at 12 weeks and 20 (8.62%) had radiographic evidence of non-union of the osteotomy sites. There was no significant relationship between NSAID use and osseous non-union (p<0.05).

Conclusions: Short-term use of oral ibuprofen and ketorolac in the post-operative period was not associated with bony non-union.

Keywords: Delayed union; Ibuprofen; Inflammation; Ketorolac; Non-union; Pain.

MeSH terms

  • Acetaminophen / therapeutic use*
  • Adult
  • Aged
  • Aged, 80 and over
  • Ankle Joint / surgery
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Drug Combinations
  • Female
  • Foot Joints / surgery*
  • Humans
  • Hydrocodone / therapeutic use*
  • Joint Diseases / surgery*
  • Ketorolac / therapeutic use*
  • Male
  • Middle Aged
  • Osteotomy / adverse effects*
  • Pain Management
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Postoperative Care / methods*
  • Retrospective Studies
  • Young Adult

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Drug Combinations
  • acetaminophen, hydrocodone drug combination
  • Acetaminophen
  • Hydrocodone
  • Ketorolac