Risks of NSAIDs Greater Than Benefits in Hip Replacement

A 2-week course of ibuprofen after total hip replacement or revision surgery can reduce ectopic bone growth, but does not reduce pain or improve mobility significantly several months after surgery and can lead to serious postoperative bleeding, a randomized study has found.

Routine prophylaxis with nonsteroidal anti-inflammatory drugs after hip surgery is believed to reduce the occurrence of ectopic bone growth, which occurs in one-third of all hip-replacement patients. Physicians believe ectopic bone growth is a determinant in the risk of long-term pain or disability. The researchers in this study examined whether postsurgical ibuprofen led to reduced pain and improved mobility 6-12 months after surgery.

Marlene Fransen of the University of Sydney, Australia, and her associates compared outcomes for 898 patients (mean age 66) in Australia and New Zealand undergoing the surgery at 20 hospitals between February 2002 and May 2004. Half were randomized to receive ibuprofen (two doses of 200 mg taken three times daily), the other half to placebo. Treatment began within 24 hours of surgery and lasted for 14 days (BMJ 2006;333:519-23).

Of the patients who received follow-up examinations 6-12 months after surgery, the 391 patients in the ibuprofen group had significantly reduced risk of developing ectopic bone of any grade (risk ratio 0.7) and severe ectopic bone (0.4), compared with the 407 patients in the placebo group.

Compared with patients on placebo, those on ibuprofen showed no statistically significant improvements in pain and physical function, such as physical activity, ability to get out of the house, walking speed, time taken to stand up from sitting in a chair, and use of analgesics.

The risks of bleeding were higher with ibuprofen. During the hospital admission, patients in the ibuprofen group were twice as likely (risk ratio 2.1) to experience a bleeding complication.

“Our results provide no evidence of clinical benefit 6 to 12 months postoperatively and raise concerns about the safety of ibuprofen for the prevention of ectopic bone formation after hip arthroplasty,” the authors wrote.

In an accompanying editorial, Fraser Birrell, consultant and senior lecturer in rheumatology, Northumbria Healthcare National Health Service Trust and School of Clinical Medical Sciences, University of Newcastle upon Tyne (England), and Stefan Lohmander, senior lecturer Department of Orthopaedics, University Hospital in Lund, Sweden, wrote that while it has been shown that use of ibuprofen and other NSAIDs reduce ectopic bone growth, the study demonstrates the risk of this practice (BMJ 2006;333:506-7).

A 2-week course of ibuprofen after total hip replacement or revision surgery can reduce ectopic bone growth, but does not reduce pain or improve mobility significantly several months after surgery and can lead to serious postoperative bleeding, a randomized study has found.

Routine prophylaxis with nonsteroidal anti-inflammatory drugs after hip surgery is believed to reduce the occurrence of ectopic bone growth, which occurs in one-third of all hip-replacement patients. Physicians believe ectopic bone growth is a determinant in the risk of long-term pain or disability. The researchers in this study examined whether postsurgical ibuprofen led to reduced pain and improved mobility 6-12 months after surgery.

Marlene Fransen of the University of Sydney, Australia, and her associates compared outcomes for 898 patients (mean age 66) in Australia and New Zealand undergoing the surgery at 20 hospitals between February 2002 and May 2004. Half were randomized to receive ibuprofen (two doses of 200 mg taken three times daily), the other half to placebo. Treatment began within 24 hours of surgery and lasted for 14 days (BMJ 2006;333:519-23).

Of the patients who received follow-up examinations 6-12 months after surgery, the 391 patients in the ibuprofen group had significantly reduced risk of developing ectopic bone of any grade (risk ratio 0.7) and severe ectopic bone (0.4), compared with the 407 patients in the placebo group.

Compared with patients on placebo, those on ibuprofen showed no statistically significant improvements in pain and physical function, such as physical activity, ability to get out of the house, walking speed, time taken to stand up from sitting in a chair, and use of analgesics.

The risks of bleeding were higher with ibuprofen. During the hospital admission, patients in the ibuprofen group were twice as likely (risk ratio 2.1) to experience a bleeding complication.

“Our results provide no evidence of clinical benefit 6 to 12 months postoperatively and raise concerns about the safety of ibuprofen for the prevention of ectopic bone formation after hip arthroplasty,” the authors wrote.

In an accompanying editorial, Fraser Birrell, consultant and senior lecturer in rheumatology, Northumbria Healthcare National Health Service Trust and School of Clinical Medical Sciences, University of Newcastle upon Tyne (England), and Stefan Lohmander, senior lecturer Department of Orthopaedics, University Hospital in Lund, Sweden, wrote that while it has been shown that use of ibuprofen and other NSAIDs reduce ectopic bone growth, the study demonstrates the risk of this practice (BMJ 2006;333:506-7).

A 2-week course of ibuprofen after total hip replacement or revision surgery can reduce ectopic bone growth, but does not reduce pain or improve mobility significantly several months after surgery and can lead to serious postoperative bleeding, a randomized study has found.

Routine prophylaxis with nonsteroidal anti-inflammatory drugs after hip surgery is believed to reduce the occurrence of ectopic bone growth, which occurs in one-third of all hip-replacement patients. Physicians believe ectopic bone growth is a determinant in the risk of long-term pain or disability. The researchers in this study examined whether postsurgical ibuprofen led to reduced pain and improved mobility 6-12 months after surgery.

Marlene Fransen of the University of Sydney, Australia, and her associates compared outcomes for 898 patients (mean age 66) in Australia and New Zealand undergoing the surgery at 20 hospitals between February 2002 and May 2004. Half were randomized to receive ibuprofen (two doses of 200 mg taken three times daily), the other half to placebo. Treatment began within 24 hours of surgery and lasted for 14 days (BMJ 2006;333:519-23).

Of the patients who received follow-up examinations 6-12 months after surgery, the 391 patients in the ibuprofen group had significantly reduced risk of developing ectopic bone of any grade (risk ratio 0.7) and severe ectopic bone (0.4), compared with the 407 patients in the placebo group.

Compared with patients on placebo, those on ibuprofen showed no statistically significant improvements in pain and physical function, such as physical activity, ability to get out of the house, walking speed, time taken to stand up from sitting in a chair, and use of analgesics.

The risks of bleeding were higher with ibuprofen. During the hospital admission, patients in the ibuprofen group were twice as likely (risk ratio 2.1) to experience a bleeding complication.

“Our results provide no evidence of clinical benefit 6 to 12 months postoperatively and raise concerns about the safety of ibuprofen for the prevention of ectopic bone formation after hip arthroplasty,” the authors wrote.

In an accompanying editorial, Fraser Birrell, consultant and senior lecturer in rheumatology, Northumbria Healthcare National Health Service Trust and School of Clinical Medical Sciences, University of Newcastle upon Tyne (England), and Stefan Lohmander, senior lecturer Department of Orthopaedics, University Hospital in Lund, Sweden, wrote that while it has been shown that use of ibuprofen and other NSAIDs reduce ectopic bone growth, the study demonstrates the risk of this practice (BMJ 2006;333:506-7).