NYC Gazette

At the American Academy of Orthopedic Surgeons (AAOS) annual meeting, researchers from the Hospital for Special Surgery (HSS) presented studies aimed at improving recovery after total knee arthroplasty (TKA), commonly known as knee replacement surgery.

One study examined the effects of tourniquet use during TKA. Traditionally used to reduce blood loss, tourniquets were found to be linked with increased pain and longer recovery times. Brian P. Chalmers, MD, co-senior author and hip and knee surgeon at HSS, stated, “We found that limiting tourniquet use was associated with slightly lower rates of opioid use to control pain after surgery and a quicker ability to complete physical therapy and leave the hospital.” Advances such as tranexamic acid (TXA) have reduced the need for tourniquets by effectively controlling bleeding.

Alejandro Gonzalez Della Valle, MD, another co-senior author and hip and knee surgeon at HSS, noted that reducing tourniquet use could lead to less pain and faster mobility post-surgery. “If you limit tourniquet use, patients will hurt less and will move sooner,” he explained. This approach can also decrease opioid consumption post-operatively.

The study revealed varying practices among surgeons regarding tourniquet usage during TKA. Some employ it throughout the procedure while others do not use it at all. Dr. Chalmers remarked on the significance of this study: “To our knowledge, this is the only paper that addresses several different ways surgeons use tourniquets during TKA.”

Another research effort focused on non-steroidal anti-inflammatory drugs (NSAIDs). Led by Peter K. Sculco, MD from HSS, it showed NSAIDs reduce the risk of developing arthrofibrosis—a condition requiring additional procedures—after TKA. “These medications are associated with lower rates of fibrotic pain and stiffness requiring an intervention such as MUA,” said Dr. Sculco.

The study involving over 23,000 patients found that those prescribed NSAIDs had a significantly lower incidence of manipulation under anesthesia (MUA) compared to those who were not prescribed these drugs. However, prolonged NSAID usage beyond four weeks did not yield further benefits.

For patients unable to take NSAIDs due to medical conditions like gastrointestinal issues or kidney problems, steroids are administered post-TKA instead. Dr. Sculco emphasized the need for further research into steroid effects on MUA rates.

Additionally, a study led by Dr. Sculco investigated local anesthetics in revision TKA surgeries—procedures addressing issues in previously replaced knee joints without infection. The introduction of extended-release dual-acting local anesthetic (ERDALA) showed promising results in patient recovery times compared to standard periarticular injections (PAI).

“ERDALA did not reduce pain scores or the total amount of opioids prescribed in this study but was associated with helping patients reach early recovery milestones sooner,” Dr. Sculco reported about ERDALA’s impact on patient outcomes following aseptic revision TKA surgeries.