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Proximal Femoral Resection for the Painful Dislocated Hip in Cerebral Palsy: Does Indomethacin Prevent Heterotopic Ossification?

Dartnell, Jo MSc, FRCS (Tr&Orth)*; H. Paterson, J. Mark FRCS; Magill, Nicholas MSc; Norman-Taylor, Fabian FRCS (Tr&Orth)*

Journal of Pediatric Orthopaedics: April/May 2014 - Volume 34 - Issue 3 - p 295–299
doi: 10.1097/BPO.0000000000000146

Background: Painful hip displacement is difficult to treat in severe cerebral palsy. Proximal femoral resection (PFR) is an excellent procedure for pain relief but has a high rate of heterotopic ossification (HO). Indomethacin is the gold standard therapy used for prevention in hip and acetabular surgery. There is no evidence of its benefit in this complex patient group.

Methods: Forty-one consecutive patients with severe cerebral palsy underwent 52 primary PFRs for severe pain in 2 pediatric orthopaedic units in London, UK. Twenty-one patients received a prophylactic postoperative dose of indomethacin for the prevention of HO. Notes and radiographs were reviewed independently by 2 orthopaedic trainees.

Results: The mean age of patients was 14.3 and 14.8 years in the group administered with and administered without indomethacin, respectively, and mean follow-up was 4.5 and 4.3 years. Five patients in each group developed HO. One patient in the indomethacin group was offered reexcision for HO but declined. Two in the nonindomethacin group were offered reexcision and one accepted and made a good recovery. There was no difference in pain relief between the groups and no correlation between the degree of HO and level of postoperative pain.

Conclusions: This study does not support the use of prophylactic indomethacin in severe cerebral palsy patients undergoing PFR. We also question the importance of HO in the outcome of this procedure.

Level of Evidence: Level III.

*Department of Paediatric Orthopaedics, Evelina London Children’s Hospital, St Thomas’ Hospital

Royal London Hospital, London, UK

King’s Clinical Trials Unit, King’s College, London, UK

The authors declare no conflict of interest.

Reprints: Jo Dartnell, MSc, FRCS (T&Orth), Department of Paediatric Orthopaedics, Evelina London Children’s Hospital, Westminster Bridge Road, London SE1 7EH, UK. E-mail:

© 2014 by Lippincott Williams & Wilkins