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Ketoralac tromethamine is a new non-steroidal anti-inflammatory drug that is being used extensively as an analgesic in orthopaedic surgery, particularly for outpatient procedures. However, as with all non-steroidal anti-inflammatory drugs there have been theoretical concerns about the effect of the drug with regard to bone metabolism and healing. In the present study bone healing of femoral osteotomies was evaluated in rats given ketoralac tromethamine in comparison with two other groups of rats given indomethacin and saline (control group), respectively. Under unstable healing conditions, 3 days of medication with indomethacin significantly reduced the femoral bending moment, bending rigidity and energy expenditure compared with the control group. Such impairment of mechanical characteristics was not found during the first 3 days after osteotomy in rats given ketoralac tromethamine. There were no significant differences in mechanical properties between the three groups when healing occurred under stable conditions. Ketoralac tromethamine is a rather new NSAID that has excellent aqueous solubility and lacks tissue irritability [2]. It is, therefore, very suitable for parenteral use. Additionally, it is the most potent NSAID known, equal or superior to morphine for pain relief following orthopaedic surgery [9]. Its use has therefore become widespread as an alternative to opioid analgesics [7]. Its effects on bone metabolism and healing have, however, not been fully elucidated, and concern has been expressed about its potential effect. The present study was designed to investigate the effects of short-term administration of ketoralac tromethamine on bone healing under stable and unstable conditions in rats, as compared to indomethacin.

Background: Severe trauma is a challenge to the immune response and may cause reduced immune capacity. As a marker of decreased cellular activity, studies with ex vivo lipopolysaccharide (LPS) stimulation of whole blood or isolated mononuclear cells from injured patients have revealed reduced production of inflammatory cytokines. To gain further insight into immune alterations in orthopaedic surgery, we studied LPS-induced tumour necrosis factor (TNF)-α and interleukin (IL)-10 in whole blood of patients during peri- and postoperative phases of total hip replacement. Methods: Four females and 3 males undergoing elective total hip replacement were included in the study. Ex vivo LPS-induced TNF-α and IL-10 were measured in a whole blood assay before, during and at 1 and 6 days after operation. In addition, the counts of white blood cells were determined. Results: During the operation, there were significant reductions in the number of monocytes, but at day 1 and 6 after surgery, there were significant increases as compared to the levels before surgery. The capacity of whole blood to express TNF-α and IL-10 did not change significantly during the operation and the following postoperative day. At day 6, however, there were significant reductions in expression of both TNF-α and IL-10 as compared to the levels before the operation. In relation to the values of monocytes, there was a significant reduction in the expression of TNF-α also at day 1 after operation. Conclusion: Our data indicate that in the course of at least 6 days after a major orthopaedic trauma, there is suppression of the whole blood capacity to express the inflammatory cytokine TNF-α and the anti-inflammatory cytokine IL-10 when exposed to LPS. During this time, then, the patient is particular susceptible to septic complications.

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