Recommended Use of Non-Steroidal Anti-Inflammatory Drugs for Pain Treatment Following Primary Total Hip and Knee Arthroplasties in Denmark. A National Survey

BACKGROUND: Non-steroidal Anti-inflammatory drugs (NSAIDs) are effective in reducing acute postoperative pain. However, it is currently unknown what type, dosage, and duration of NSAID are used following primary total hip and knee arthroplasties. We aimed to investigate the use of NSAID following total hip and knee arthroplasties in Denmark, describe general postoperative analgesic regimens, and assess clinicians' attitudes towards NSAID treatment.

METHOD: We conducted a web-based survey distributed to local clinicians responsible for total hip and knee arthroplasties in all public Departments of Orthopedic Surgery in Denmark. The survey focused on standard perioperative treatment practices, and in particular the use of NSAIDs.

RESULTS: Of the 40 surgeons invited, 98% responded. The majority (37 of 39, 95%) reported NSAIDs as part of standard analgesic regimes after primary total hip and knee arthroplasties. Ibuprofen was the most commonly used NSAID postoperatively (26 of 37, 70%), typically administered at 1200 mg/day (20 of 26, 77%). The median duration of treatment was 8 days (interquartile range (IQR) 6-12) for total hip arthroplasties and 14 days (IQR 10-14) for total knee arthroplasties. However, there were significant variations between hospitals and regions. Multimodal analgesic treatment using paracetamol, NSAIDs, and opioids was the most common analgesia following total hip and knee arthroplasties. Nine of 38 (24%) were concerned regarding daily clinical treatment with NSAID.

CONCLUSION: NSAIDs, especially ibuprofen, are routinely recommended as part of multimodal therapy for postoperative pain after primary total hip and knee arthroplasties in Denmark. The standard dose is 1200 mg/day, with a median treatment duration of 8 days for total hip arthroplasties and 14 days for total knee arthroplasties, though practices vary across different hospitals and regions.