Dr. Charles M. Lawrie, M.D., MSc, an orthopedic surgeon with Baptist Health Orthopedic Care, in south Florida, is the 2023 recipient of the Chitranjan Ranawat Award. The award is given to one research paper each year identified by The Knee Society as the most impactful research regarding total knee replacement related care. Dr. Lawrie presented his research paper March 7 at the Knee Society/American Association of Hip and Knee Surgeons Specialty Day in Las Vegas.
The paper, “Tourniquet use does not impact trajectory of total knee arthroplasty early recovery: A prospective, randomized controlled trial,” was published in the Journal of Arthroplasty. It describes results from a recent study that examined the impact of tourniquet use on patient recovery from knee arthroplasty, addressing a controversial topic among knee replacement providers.
“Traditionally, surgeons have used tourniquets during knee arthroplasty procedures to decrease blood loss, improve visualization of the surgical field and potentially help implants attach to bones more effectively,” said Dr. Lawrie. “However, with a growing interest in rapid patient recovery after total knee replacement, surgeons questioned whether the pressure from a tourniquet might be causing muscle damage and thereby hampering recovery. So, the role of tourniquets started to come under scrutiny.”
These concerns sparked new research into the effects of tourniquet use. Specifically, researchers wanted to determine if tourniquets caused muscle damage, increased pain in the leg and prevented rapid recovery. However, whether or not this is the case has remained unclear to orthopedic surgeons.
“More recent, high-quality studies have at least shown there is no significant difference in patient pain levels with tourniquet use or outcomes in the four to six weeks following surgery. However, little research has been done in the ‘black hole of recovery’ period — that time after a patient leaves the hospital before you next see them in the office,” said Dr. Lawrie. “This study helps address that gap and provide more clarity on tourniquet use.”
No Significant Difference in Recovery Outcomes
In the study, 107 participants underwent knee arthroplasty with or without a tourniquet. Dr. Lawrie and his team concluded that tourniquet use had no major impact on daily participant pain levels or functional recovery during the first six weeks after surgery. These findings provide more certainty in the conversation about tourniquet use.
Digital Technologies Offered a Granular Look at Knee Arthroplasty Recovery
Dr. Lawrie’s study deployed a unique approach to tracking patient functional recovery: a smartphone-based patient engagement platform (PEP) and wearable activity monitors. Participants completed daily surveys about their functional recovery (e.g., pain medication usage, use of a cane or walker, etc.) as well as surveys about their overall pain levels via the PEP. The wrist-based activity monitor gathered data about step counts, sleep habits and heart rates. The results created a robust image of patient recovery following knee arthroplasty.
“With all these different data points coming in, we were able to create a really granular picture of what these patients look like while recovering from knee arthroplasty surgery in this ‘black hole’ timeframe,” said Dr. Lawrie.
Dr. Lawrie also highlights that the PEP, in particular, drove high rates of participant compliance with study activities, highlighting the role of digital tools in knee replacement recovery protocols.
“We had surprisingly high compliance when it came to completing surveys, largely because patients saw the PEP as another important recovery tool. On our end, their sustained engagement provided crucial data points. In the end, these tools enabled us to fully engage patients in their recovery,” he said.
Improving the Rapidity of Patient Recovery
While the study findings highlighted no significant difference between tourniquet use and no use, results also reinforced the role digital technologies can play in patient recovery. Specifically, these tools could change how orthopedic specialists can monitor and manage patient recovery efforts.
“This study was a great case example of using digital remote monitoring tools to get a better idea of what patients look like in the early recovery period and not just relying on the snapshots we normally get of patients four to six weeks after surgery,” says Dr. Lawrie. “It laid the groundwork for future research on improving the rapidity of patient recovery following knee replacement surgery.”
Baptist Health Orthopedic Care offers comprehensive care for orthopedic conditions affecting the bones and joints. Our board-certified physicians specialize in treatments and procedures designed to get you moving again, including joint replacements.