Hospital for Special Surgery (HSS) has released results from several studies focused on the use of targeted medications in joint replacement surgery. The research, presented at the annual meeting of the American Academy of Orthopaedic Surgeons, examined medication management during hip and knee replacement procedures and its impact on patient recovery, safety, and long-term outcomes.
One study titled “Aspirin Versus Potent VTE Chemoprophylaxis (VTEC) in Total Knee Arthroplasty: Reduced Postoperative Pain and Complications with Aspirin Use” included 28,169 total knee arthroplasty patients treated between 2016 and 2023. Of these, 18,413 received aspirin while 9,756 were given a more potent blood thinner. Patients were monitored for 90 days after surgery. The findings indicate that aspirin may be preferable for reducing postoperative pain in these patients.
Brian P. Chalmers, MD, a hip and knee surgeon at HSS and one of the study’s authors, explained: “We have always known that non-steroidal anti-inflammatory medications can improve patients’ swelling and inflammation after surgery. However, the traditional thought and belief has been that we should avoid those in patients on anticoagulation. Our data show there is less risk and less postoperative pain when these patients are utilizing aspirin.”
A second study called “The Effect of Concomitant Use of Potent Anticoagulation and Anti-Inflammatories on Early Outcomes of Total Hip Arthroplasty” looked at 5,881 total hip arthroplasty patients who were prescribed anticoagulants between 2016 and 2023. Among them, 4,867 also received NSAIDs while 1,040 had only anticoagulation therapy. The researchers found that using NSAIDs alongside anticoagulants did not increase wound-related bleeding complications.
Dr. Chalmers stated: “The conventional thinking has often been that patients on an anticoagulant should not be on an NSAID, that there is going to be bleeding, more risk of wound problems and additional complications. But based on our retrospective data, we did not see increased risk in patients using both anticoagulation and NSAIDs. We did see some additional benefits, including less pain and a somewhat easier recovery.” He added: “NSAIDs appear to be safe in this setting and may help decrease postoperative pain and reduce opioid use following surgery.”
The third study titled “Cefazolin and the R-1 Side Chain: Why Your Joint Arthroplasty Patients With Cephalosporin Allergy Can Safely Be Given Cefazolin” assessed whether cefazolin could be safely administered to joint replacement patients with documented cephalosporin allergies. Researchers compared outcomes among 89,993 hip and knee arthroplasty patients from 2016 to 2024; out of these, 1,267 had a reported allergy but still received perioperative cefazolin instead of alternative antibiotics. No cases of severe allergic reactions were reported.
Matthew S. Austin, MD, hip and knee surgeon at HSS and study author said: “When patients have a mild allergic reaction, there is often a reflex to give them another antibiotic in a different family of drugs. However, alternative options aren’t always as effective,” he said. “Clear protocols should be put in place to guide decision-making when managing these types of allergies.”
These studies demonstrate HSS’s ongoing work to challenge established assumptions through research aimed at refining care before and after surgery for joint replacement patients.
HSS is recognized for its specialized orthopedic care as well as its research efforts in musculoskeletal health (official website). The hospital has consistently ranked highly in orthopedics while earning multiple Magnet designations for nursing excellence (official website). Its mission includes improving mobility through high-quality care as well as advancing orthopedic surgery research (official website). HSS also extends its services through partnerships in regions such as Southwest Florida (official website).