{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:35:03Z","timestamp":1785256503073,"version":"3.55.0"},"reference-count":28,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Ketorolac is commonly used for pain management after orthopedic surgery, but concerns regarding its effects on postoperative complications remain. This study evaluates the impact of ketorolac use on short- and long-term outcomes in adult patients undergoing uncemented primary total hip arthroplasty (THA), where implant stability relies on biological fixation through bone ingrowth into a porous-coated prosthesis rather than bone cement. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 18 years or older who underwent uncemented primary THA between 1 January 2004 and 1 January 2024 were included. Two cohorts were compared: those who received ketorolac on the day of or within one week of surgery and those who did not. Cohorts were propensity score-matched. Outcomes were assessed at 30 days, 1 year, and 5 years postoperatively. Results: At 30 days, ketorolac use was associated with significantly lower risks of transfusion (RR: 0.6, p &lt; 0.01). However, it was linked to higher rates of acute posthemorrhagic anemia (RR: 1.2, p &lt; 0.01) and periprosthetic fracture (RR: 1.4, p &lt; 0.01). At 1 year, ketorolac use was associated with reduced risks of death (RR: 0.8, p &lt; 0.01) and transfusion (RR: 0.7, p &lt; 0.01), but increased risks of acute posthemorrhagic anemia (RR: 1.2, p &lt; 0.01), deep surgical site infection (SSI) (RR: 1.8, p = 0.01), superficial SSI (RR: 1.9, p &lt; 0.01), periprosthetic joint infection (RR: 1.1, p &lt; 0.01), wound dehiscence (RR: 1.2, p &lt; 0.01), periprosthetic mechanical complication (RR: 1.2, p &lt; 0.01), and periprosthetic fracture (RR: 1.5, p &lt; 0.01). Conclusions: Our findings highlight the complex risk profile of ketorolac in uncemented THA patients and suggest that clinicians should carefully consider individual patient factors and engage in shared decision-making when counseling patients on the use of ketorolac in the perioperative setting.<\/jats:p>","DOI":"10.3390\/jcm14144956","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T10:55:41Z","timestamp":1752490541000},"page":"4956","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating the Effects of Perioperative Ketorolac Use on Uncemented Total Hip Arthroplasty Outcomes"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8837-0396","authenticated-orcid":false,"given":"Mehul M.","family":"Mittal","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2738-4564","authenticated-orcid":false,"given":"David","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia F.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varatharaj","family":"Mounasamy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"},{"name":"Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, TX 75216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senthil N.","family":"Sambandam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"},{"name":"Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, TX 75216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gademan, M.G.J., Hofstede, S.N., Vlieland, T.P.M.V., Nelissen, R.G.H.H., and Marang-van de Mheen, P.J. (2016). Indication Criteria for Total Hip or Knee Arthroplasty in Osteoarthritis: A State-of-the-Science Overview. BMC Musculoskelet. Disord., 17.","DOI":"10.1186\/s12891-016-1325-z"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.1016\/j.arth.2018.05.015","article-title":"The \u201cBundle Busters\u201d: Incidence and Costs of Postacute Complications Following Total Joint Arthroplasty","volume":"33","author":"Luzzi","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1016\/j.arth.2020.05.035","article-title":"The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis","volume":"35","author":"Fillingham","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1007\/s00167-012-2095-2","article-title":"The Effect of Nonsteroidal Anti-Inflammatory Drugs on Tissue Healing. Knee Surg","volume":"21","author":"Chen","year":"2013","journal-title":"Sports Traumatol. Arthrosc. Off. J. ESSKA"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nakata, H., Shelby, T., Wang, J.C., Bouz, G.J., Mayfield, C.K., Oakes, D.A., Lieberman, J.R., Christ, A.B., and Heckmann, N.D. (2023). Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty. J. Clin. Med., 12.","DOI":"10.3390\/jcm12226969"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e158","DOI":"10.1097\/BOT.0000000000001430","article-title":"Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury","volume":"33","author":"Hsu","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jclinane.2018.06.020","article-title":"The Effect of Nonsteroidal Anti-Inflammatory Drugs on Bone Healing in Humans: A Qualitative, Systematic Review","volume":"49","author":"Borgeat","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"606404","DOI":"10.1100\/2012\/606404","article-title":"Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis","volume":"2012","author":"Pountos","year":"2012","journal-title":"Sci. World J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.arth.2015.08.012","article-title":"Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib","volume":"31","author":"Warth","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_10","first-page":"CD013263","article-title":"Single-Dose Intravenous Ketorolac for Acute Postoperative Pain in Adults","volume":"5","author":"McNicol","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","first-page":"e8","article-title":"Cemented versus Uncemented Fixation in Total Hip Replacement: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"5","author":"Abdulkarim","year":"2013","journal-title":"Orthop. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"43S","DOI":"10.1016\/S0002-9343(00)00684-7","article-title":"Potential Impact of Selective Cyclooxygenase-2 Inhibitors on Bone Metabolism in Health and Disease","volume":"110","author":"Raisz","year":"2001","journal-title":"Am. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1359\/jbmr.2002.17.6.963","article-title":"Cyclo-Oxygenase 2 Function Is Essential for Bone Fracture Healing","volume":"17","author":"Simon","year":"2002","journal-title":"J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res."},{"key":"ref_14","unstructured":"(2024, July 01). Linked EHR and Claims. Available online: https:\/\/trinetx.com\/real-world-data\/linked\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"66","DOI":"10.2106\/JBJS.23.01225","article-title":"Effect of Ketorolac Administration on the Rate of Nonunion of Operatively Treated Pediatric Long-Bone Fractures: A Matched Cohort Analysis","volume":"107","author":"Pereira","year":"2024","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"McGettigan, P., and Henry, D. (2011). Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies. PLoS Med., 8.","DOI":"10.1371\/journal.pmed.1001098"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1136\/bmj.332.7553.1302","article-title":"Do Selective Cyclo-Oxygenase-2 Inhibitors and Traditional Non-Steroidal Anti-Inflammatory Drugs Increase the Risk of Atherothrombosis? Meta-Analysis of Randomised Trials","volume":"332","author":"Kearney","year":"2006","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1097\/j.pain.0000000000001047","article-title":"Opioid Prescription Levels and Postoperative Outcomes in Orthopedic Surgery","volume":"158","author":"Cozowicz","year":"2017","journal-title":"Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1177\/1060028017694655","article-title":"Continuous Infusion Ketorolac for Postoperative Analgesia Following Unilateral Total Knee Arthroplasty","volume":"51","author":"Schwinghammer","year":"2017","journal-title":"Ann. Pharmacother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1038\/clpt.1988.70","article-title":"Effects of Ketorolac Tromethamine on Hemostasis in Volunteers","volume":"43","author":"Conrad","year":"1988","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"71S","DOI":"10.1002\/j.1875-9114.1990.tb03583.x","article-title":"Effects of Ketorolac Tromethamine on Hemostasis","volume":"10","author":"Greer","year":"1990","journal-title":"Pharmacotherapy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8836","DOI":"10.7150\/thno.63396","article-title":"Role of Prostaglandin E2 in Tissue Repair and Regeneration","volume":"11","author":"Cheng","year":"2021","journal-title":"Theranostics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.21037\/aoj-23-58","article-title":"The Effect of Nonsteroidal Anti-Inflammatory Drug Use on Soft Tissue and Bone Healing in the Knee: A Systematic Review","volume":"9","author":"Solaiman","year":"2024","journal-title":"Ann. Jt."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1038\/70995","article-title":"Inhibition of Angiogenesis by Nonsteroidal Anti-Inflammatory Drugs: Insight into Mechanisms and Implications for Cancer Growth and Ulcer Healing","volume":"5","author":"Jones","year":"1999","journal-title":"Nat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"76","DOI":"10.12968\/jowc.2007.16.2.27001","article-title":"The Effects of Non-Steroidal Anti-Inflammatory Drug Application on Incisional Wound Healing in Rats","volume":"16","author":"Krischak","year":"2007","journal-title":"J. Wound Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1152\/japplphysiol.00053.2013","article-title":"NSAID Therapy Effects on Healing of Bone, Tendon, and the Enthesis","volume":"115","author":"Su","year":"2013","journal-title":"J. Appl. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3814","DOI":"10.1016\/j.arth.2021.06.017","article-title":"Preoperative Opioid Use Is Associated With Higher Revision Rates in Total Joint Arthroplasty: A Systematic Review","volume":"36","author":"Malahias","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.2106\/JBJS.17.01414","article-title":"Preoperative Opioid Use Is Associated with Higher Readmission and Revision Rates in Total Knee and Total Hip Arthroplasty","volume":"100","author":"Weick","year":"2018","journal-title":"J. Bone Jt. Surg. Am."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4956\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:14Z","timestamp":1760033354000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,13]]},"references-count":28,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14144956"],"URL":"https:\/\/doi.org\/10.3390\/jcm14144956","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,13]]}}}