NSAIDs and bone healing

NewsBot · Jun 1, 2019

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The effect of post-operative NSAID administration on bone healing after elective foot and ankle surgery
Mohammed K.HassanaLawrence G.Karlock
Foot and Ankle Surgery; 31 May 2019

Highlights
•The association of NSAID use and bone healing complications are illustrated in many animal studies
•There is a paucity of high-quality literature to establish the association between NSAID use and nonunion of bone after foot and ankle surgery
•No strong association was seen between Ibuprofen and Ketorolac use and osseous nonunion at 12 weeks
•Short duration oral Ibuprofen and Ketorolac appears safe and effective for post-operative pain management
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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.
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NewsBot · Jan 31, 2023

The Effects of NSAIDs on Foot and Ankle Arthrodesis Procedures, A Retrospective Chart Review
Kelly M. Pirozzi, DPM, FACFAS et al
January 25, 2023

The opioid epidemic has forced practitioners to look to other means for pain control. This has made non-steroidal anti-inflammatory medications (NSAIDs) much more prevalent. Advantageous as it might seem, a closer look at the pharmacodynamics shows that by inhibiting COX enzymes, NSAIDs are inhibiting prostaglandin which could inhibit bone healing. Our objective is to determine if NSAID use during foot and ankle arthrodesis inhibits bone healing. We reviewed the electronic database of patients who underwent foot and/or ankle arthrodesis with the inclusion criteria of fusion CPT codes. Exclusion was younger than 18 years old, active infection, revisional arthrodesis, less than 3 months follow-up XXXXXXX, no postoperative radiographs available, and death prior to fusion. One-hundred and sixty-one procedures in 155 patients were included and split into two groups. Group 1 included patients without non-union (n=122) and Group 2, included patients with non-union (n=39). NSAID use presented in 40 (33%) of procedures in Group 1 compared to 11 (28%) of procedures in Group 2 (Table 2). The mean days on NSAIDs was 51.2 ± 36.1 days in Group 1 compared to 52.2 ± 51.2 days in Group 2 with no statistical difference between groups. Time to fusion was longest in patients on NSAIDs (110 days) or both NSAIDs and active Tobacco use (114 days) and shortest in patients on active Tobacco (93 days) or no NSAIDS and tobacco use (93.61 days). NSAID use did not appear to affect ability to obtain joint fusion, but does appear to delay time to fusion.
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