BMJ 2006;333:519

Safety and efficacy of routine postoperative ibuprofen for pain and disability related to ectopic bone formation after hip replacement surgery (HIPAID): randomised controlled trial

Marlene Fransen, senior research fellow 1, Craig Anderson, director, neurological and mental health division1, Jan Douglas, project manager1, Stephen MacMahon, principal director1, Bruce Neal, director, cardiac and renal division1, Robyn Norton, principal director1, Mark Woodward, director, epidemiology and biostatistics division1, Ian D Cameron, director and professor of rehabilitation medicine2, Ross Crawford, professor of orthopaedic research3, Sing Kai Lo, associate professor of biostatistics4, Garnet Tregonning, orthopaedic surgeon5, Margaret Windolf, research nurse HIPAID Collaborative Group6

Hip

Objectives To determine the benefits and risks of a non-steroidal anti-inflammatory drug (NSAID) as prophylaxis for ectopic bone formation in patients undergoing total hip replacement (or revision) surgery.

Design Double blind randomised placebo controlled clinical trial, stratified by treatment site and surgery (primary or revision).

Setting 20 orthopaedic surgery centres in Australia and New Zealand.

Participants 902 patients undergoing elective primary or revision total hip replacement surgery.

Intervention 14 days’ treatment with ibuprofen (1200 mg daily) or matching placebo started within 24 hours of surgery.

Main outcome measures Changes in self reported hip pain and physical function 6 to 12 months after surgery (Western Ontario and McMaster University Arthritis index).

Results There were no significant differences between the groups for improvements in hip pain (mean difference −0.1, 95% confidence interval −0.4 to 0.2, P = 0.6) or physical function (−0.1, −0.4 to 0.2, P = 0.5), despite a decreased risk of ectopic bone formation (relative risk 0.69, 0.56 to 0.83) associated with ibuprofen. There was a significantly increased risk of major bleeding complications in the ibuprofen group during the admission period (2.09, 1.00 to 4.39).

Conclusions These data do not support the use of routine prophylaxis with NSAIDs in patients undergoing total hip replacement surgery.

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