SAN DIEGO, March 11, 2025 -(BUSINESS WIRE)- At this year’s American Academy of Orthopedic Surgeons (AAOS) annual meeting, investigators at Hospital for Special Surgery (HSS) presented several significant studies, with three focused on new ways to help patients recover faster after total knee arthroplasty (TKA), also known as knee replacement surgery.
What follows are highlights from these studies:
Limiting Use of Tourniquets During Knee Replacement Surgery Improves Patient Outcomes
Tourniquets have traditionally been used during TKA to reduce blood loss and the need for transfusions. However, a new study of almost 18,000 patients from 2019 to 2023 found that prolonged tourniquet use was linked to increased pain, higher opioid use, and a longer recovery.
“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,” said Brian P. Chalmers, MD, hip and knee surgeon at HSS and co-senior author of the study.
Thanks to advances in medicine and technology, tourniquets may not be needed as often. For example, tranexamic acid (TXA) is now commonly used to effectively reduce bleeding and lower the likelihood of patients requiring a blood transfusion.
“If you have a drug that has this beneficial effect, then the need for a tourniquet may be reduced,” explained Alejandro Gonzalez Della Valle, MD, hip and knee surgeon at HSS and co-senior author of the research. “If you limit tourniquet use, patients will hurt less and will move sooner, and that will allow patients to go home sometimes the same day.”
Dr. Della Valle notes that limiting tourniquet use can also reduce opioid consumption. The reason that tourniquet use during TKA has been associated with increased post-operative pain is because the device compresses the quadricep and hamstring muscles to restrict blood flow during the operation. The increased pain may impact the time it takes to complete rehabilitation.
Surgeons have also traditionally used tourniquets to keep the area between the knee implant and the bone as dry as possible, which helps bone cement create a stronger bond between the bone and the implant, potentially reducing the risk of loosening over time.
“Recent studies have shown that you can obtain a dry field without using a tourniquet, reducing its necessity during TKA,” explained Dr. Chalmers.
Another development that has lessened the need for the use of tourniquets is cementless fixation, in which a specially-designed implant that allows the bone to grow into the implant and achieve long-term fixation without the use of cement.
There is currently no consensus in the literature or among surgeons throughout the country on the use of tourniquets during TKA. Surgeons use these devices differently based on individual patient needs. Some use a tourniquet from the time of incision until the implant is fixated to the bone, while others use it only during cementation or throughout the entire procedure until the wound is closed and the dressings are in place. Some surgeons may opt not to use a tourniquet at all.
“What sets this study apart is that it captures what surgeons are doing in their daily practice,” said Dr. Chalmers. “To our knowledge, this is the only paper that addresses several different ways surgeons use tourniquets during TKA, including no usage, limited usage, and full usage.”
The study’s authors conclude that reduced tourniquet use should be considered within the realm of multiple advances that help patients recover faster after surgery and with less pain. These include newer drugs and tools used to reduce pain and blood loss during surgery, two major factors that often prolong hospital stays.
“Any measures we can take around the time of surgery to help those factors can significantly improve patient outcomes,” said Dr. Della Valle.
NSAIDs Reduce Risk of Fibrosis Needing Further Treatment after Knee Replacement Surgery
A new study led by surgeons at HSS shows that patients who were prescribed a non-steroidal anti-inflammatory drug (NSAID) after TKA had a reduced risk of developing painful scar tissue, a condition known as arthrofibrosis, which often requires additional procedures. The findings also shed light on the durations for NSAID use to prevent fibrosis following surgery.
In arthrofibrosis, excessive scar tissue forms in and around a joint after an operation. It can lead to stiffness, pain and reduced range of motion in the joint. Approximately 2% to 6% of patients require a minimally invasive procedure called manipulation under anesthesia (MUA) to treat this complication.
The researchers found that patients who were prescribed an NSAID had a significantly lower incidence of MUAs (5.3%) 90 days after surgery compared to those who did not have an NSAID prescription (12.6%). The study included more than 23,000 people who had TKA at HSS between 2017 and 2021.
“This study highlights the importance of NSAID use for early recovery after TKA,” says Peter K. Sculco, MD, hip and knee surgeon at HSS and senior author of the study. “These medications are associated with lower rates of fibrotic pain and stiffness requiring an intervention such as MUA.”
He added that decreased risk was not seen in patients who used NSAIDs for more than four weeks, suggesting patients stop within one month’s time to get the most benefit.
Some patients, however, cannot use NSAID medications due to risk of bleeding or gastrointestinal or kidney issues.
“We now use steroids for one week after TKA in patients who are unable to take NSAIDs,” explained Dr. Sculco. “However, further research is necessary to determine the effect of steroids on MUA rates and the appropriate dose and duration for this group of patients.”
Local Anesthetic Leads to Better Patient Outcomes after Revision Knee Replacement Surgery
A new study led by surgeons at HSS found that the use of a new local anesthetic at the time of revision TKA enabled patients to leave the hospital sooner and recover faster.
According to the findings, a recently introduced pain medication known as extended-release, dual-acting local anesthetic (ERDALA) used at the time of aseptic revision TKA was associated with better patient outcomes. These included completing physical therapy sooner, shorter hospital stays, and more patients being discharged within one day after surgery.
Approximately 5% to 10% of patients need aseptic revision TKA, a surgical procedure done to address loosening, stiffness, or instability of a non-infected knee joint that was previously replaced with TKA.
The study reviewed outcomes of 171 patients who had aseptic revision TKA at HSS between January 2021 and May 2023. Patients either received ERDALA (51.5%) or standard of care periarticular injections (PAI) (48.5%) during surgery. The researchers found that patients who received ERDALA went home nearly a day sooner and cleared physical therapy approximately 20 hours faster than those who received 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,” noted Dr. Peter Sculco, who is also senior author of this study. “This medication can be a valuable tool in rapid recovery strategies used in aseptic revision TKA, which can lead to patients walking better and getting home faster.”
He added that further research is needed to explore these strategies in the revision population, especially as more revision surgeries are performed in the outpatient setting.
About HSS
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2024-2025). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fifth consecutive year (2025). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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