NSAIDS and Fusion Rates

by Vince Vacketta, DPM

A short course of ketorolac doesn’t impair bone healing after first metatarsophalangeal joint (MTPJ) fusion, with union rates remaining consistent with historical benchmarks, offering a safe, opioid-sparing pain management strategy.

In the study titled “Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis” by A. Kachooei et al., a retrospective analysis of 181 cases performed by a single surgeon from 2016 to 2020 was conducted with a three-month follow-up period. 

The surgical procedure involved a standard cup-and-cone preparation with the addition of a dorsal plate. The pain management protocol included administering 30 mg of intravenous ketorolac perioperatively, followed by 10 mg orally every six hours for five days, with a maximum dosage of 40 mg per day.

Ketorolac safe post-MTPJ fusion

The key finding is that the nonunion rate was 8.3% (15 out of 181 cases), which, when compared to the historical rate of approximately 5.4%, showed a no statistically significant difference.

Why it matters

The importance of this study lies in addressing the longstanding avoidance of NSAIDs have long been avoided post-fusion for fear of nonunion.

The takeaway is that using ketorolac for up to five days is a safe adjunct for pain control after first MTPJ fusion, as it does not increase the risk of nonunion – at least in this short-term, non-controlled study.