Selected Instructional Course Lecture   |    
Nonsteroidal Anti-Inflammatory Drugs in Orthopaedics
Omar Abdul-Hadi, MD1; Javad Parvizi, MD2; Matthew S. Austin, MD2; Eugene Viscusi, MD3; Thomas Einhorn, MD4
1 Southern Oregon Orthopedics, 2780 East Barnett Road, Suite 200, Medford, OR 97504. E-mail address: ortho75@gmail.com
2 Rothman Institute of Orthopedics at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
3 Department of Anesthesiology, Thomas Jefferson University Hospital, 524 Main Building, 132 South 10th Street, Philadelphia, PA 19107
4 Department of Orthopaedic Surgery, Boston University Medical Center, 720 Harrison Avenue, Suite 808, Boston, MA 02118
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits or a commitment or agreement to provide such benefits from commercial entities of less than $10,000 (DePuy, EKR Therapeutics, Adolor, GlaxoSmithKline, Wyeth, and Cadence) and in excess of $10,000 (Stryker and Smith and Nephew).
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2010 in Instructional Course Lectures, Volume 59. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):2020-2027
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Nonsteroidal anti-inflammatory drugs are widely used and prescribed in the United States. Between 35 and 70 million prescriptions for nonsteroidal anti-inflammatory drugs are written in the United States each year, and numerous agents are now available over the counter1. In particular, the prescription of cyclooxygenase-2 (COX-2) inhibitors has become widespread since they were approved by the U.S. Food and Drug Administration in 1999, and in 2000 nearly 45 million prescriptions were written for celecoxib and rofecoxib2. More than 17 million Americans use various nonsteroidal anti-inflammatory drugs on a daily basis. Moreover, it has been estimated that 5% to 7% of all hospital admissions are related to adverse drug reactions, with nonsteroidal anti-inflammatory drugs being the culprit in 30% of these cases3. As a result of the aging of the population, there will be an increase in the use of nonsteroidal anti-inflammatory drugs parallel to the increase in the prevalence of painful degenerative musculoskeletal conditions. Despite the rising popularity of COX-2 inhibitors, their role in orthopaedic surgery remains controversial. Several studies have demonstrated the inhibitory effect of COX-2 inhibitors on bone-healing, and the inhibitory effect of traditional nonsteroidal anti-inflammatory drugs is already well known4. The use of COX-2 inhibitors is growing in the elderly population, and there are multiple concerns regarding the adverse side effects and the theoretical basis of safety of COX-2 inhibitors in orthopaedic patients.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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