Randomised trial of ibuprofen for the prevention of ectopic bone-related pain and disability after hip replacement

关节置换术是治疗严重髋关节骨关节炎的一种行之有效的方法。虽然大多数患者从手术中获益良多，但许多患者在手术后仍会经历一些疼痛和残疾。新的证据表明，这种疼痛和残疾的一个重要原因可能是手术后最初几个月髋关节周围肌肉中形成的异常骨沉积（异位骨形成）。在所有髋关节置换术患者中，约有40%的患者出现异位骨形成。如果形成范围很广，则髋关节失去所有活动，需要进行翻修手术。然而，即使形成不那么严重，髋关节的活动也会受到限制，导致疼痛和残疾。越来越多的证据表明，在手术时使用非甾体抗炎药治疗可能会使异位骨形成的风险降低一半。虽然这有望降低术后疼痛和残疾的风险和严重程度，但很少有证据表明这些药物对髋关节置换术后的长期影响。由于这个原因，再加上对这些药物可能产生的副作用的担忧，骨科医生通常不愿意常规地开这些药物来预防异位骨形成。布洛芬似乎是副作用风险最低的非甾体抗炎药。如果它能有效地减少髋关节置换术后异位骨形成引起的疼痛和残疾的发生率，那么医生和患者都很有可能认为它是值得的。如果这些益处得以实现，这种预防策略可能是一种极具成本效益的方法，可以改善快速增长的接受髋关节置换术患者的长期预后。这项研究将为在澳大利亚接受髋关节置换术的1000名患者中布洛芬的短期和长期效果提供可靠的证据。

Joint replacement is a well-established treatment for severe osteoarthritis of the hip. While most patients benefit substantially from the procedure, many still experience some pain and disability after surgery. New evidence suggests that one important cause of this pain and disability may be abnormal bone deposits that form in the muscles around the hip (ectopic bone formation) during the first few months after surgery. Ectopic bone formation is seen in about 40% of all patients with hip replacements. If the formation is extensive, all movement of the hip is lost and revision surgery is necessary. However, even when the formation is less severe, movement at the hip can be restricted resulting in pain and disability. There is growing evidence that treatment with a non-steroidal anti-inflammatory drug at the time of surgery may halve the risk of ectopic bone formation. While this would be expected to decrease the risk and severity of post-operative pain and disability, there is little evidence available about the long-term effects of these drugs after hip replacement. For this reason, together with concerns about possible side-effect of these drugs, orthopaedic surgeons have generally been reluctant to prescribe these drugs routinely for the prevention of ectopic bone formation. Ibuprofen appears to be the non-steroidal anti-inflammatory drug with the lowest risk of side effects. If it was shown to be effective in reducing the incidence of pain and disability associated with ectopic bone formation after hip replacement, it may well be considered worthwhile by doctors and patients alike. If such benefits were realised, this preventive strategy is likely to be a highly cost-effective way to improve long-term outcome among the rapidly growing numbers of patients that receive hip replacements. This study will provide reliable evidence about the short and long-term effects of ibuprofen among 1,000 patients receiving hip replacements in Australia.