PROPHYLACTIC NON-STEROIDAL ANTI-INFLAMMATORY AGENTS IN TOTAL HIP ARTHROPLASTY

Abstract

A recent systematic overview of 213 studies of more than 50,000 patients showed that ectopic bone formation (EBF) is present on the radiographs of about 40% of all patients who have undergone elective hip arthroplasty and in at least half of these, EBF is rated moderate to severe and is associated with an increased risk of an impaired functional outcome. A recent meta-analysis of more than a dozen trials of NSAIDs in patients at risk of EBF has demonstrated that perioperative treatment reduces the risk of EBF by about 50%. However, prophylaxis is rarely given in clinical practice due to concerns about perioperative bleeding, gastrointestinal events and implant loosening, combined with a lack of data on the clinical importance of EBF. The HIPAID study involves the conduct of a randomized double blind clinical trial, designed to assess the effects of a 15 day peri-operative course of ibuprofen (1200mg daily) on the clinical consequences of EBF in individuals undergoing total hip replacement surgery. The trial will be conducted in 20 orthopaedic centers throughout Australia and New Zealand, and will involve 1,000 patients aged 60 to 80 years, scheduled for elective total hip replacement surgery. The primary study outcomes are self-reported pain and physical function, assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), six months after surgery. Secondary outcomes include EBF, health-related quality of life (SF-36v2), patient’s global assessment, hip flexion and the 50ft walk time. Peri- and early postoperative events will be assessed including bleeding and gastro-intestinal complaints.