Replacement hips and anti-inflammatories don’t mix

The use of anti-inflammatory drugs following hip replacement could do more harm than good, according to a study just published in the British Medical Journal.

The study, by The George Institute for International Health in association with orthopedic centres in Australia and New Zealand, measured the effects of a short post-operative course of anti-inflammatories on the development of ectopic (abnormal) bone formation related pain and disability six to 12 months after surgery.

Dr Marlene Fransen, principal investigator of the study, said that the abnormal bone that could form around the soft tissues around the operated hip occurred in more than one third of patients after hip replacement surgery.

Many surgeons prescribed anti-inflammatory drugs in the immediate post-operative period to avoid this outcome, or as part of a pain management strategy. But while the researchers found the use of post-operative ibuprofen did greatly reduce the risk of ectopic bone formation, patients reported no greater reduction in hip pain or physical disability six to 12 months after surgery compared with those not taking the drug.

However, there was evidence suggesting that there may be an increased risk of major bleeding in patients who did take the drug. Dr Fransen said that “for this reason our study shows that recommending a routine course of an anti-inflammatory drug following hip replacement surgery is not justified”.

Over 900 patients from 20 orthopedic centres across Australia and New Zealand participated in the study with half of them allocated to receive the common anti-inflammatory drug ibuprofen for 14 days immediately after surgery.