Good Morning.

Weren't able to attend last week's AAOS annual meeting in New Orleans, or just want a recap on the top research presented at the conference?

We've got you covered.

In this edition of The Pulse, we highlight some of the highest quality scientific evidence presented at this year's conference -- to help you make better, more informed clinical decisions.

In today's edition:

🏛️ AAOS 2026: Surgeon-performed adductor canal block in same-day TKA

🏛️ AAOS 2026: Extended oral tranexamic acid

🏛️ JBJSxOE: sign up for the spine surgery online diploma course

For same-day discharge total knee arthroplasty to be successful, adequate pain management is essential. Adductor canal blocks have proven effective, but typically require anesthesiologists which can increase the cost and complexity of the operation. Allowing the surgeon to perform the adductor canal block may be a solution, but its efficacy vs. the anesthesiologist-performed, ultrasound-guided approach was necessary.

160 patients undergoing same-day total knee arthroplasty surgery were randomized to receive an anatomic-guided, surgeon-performed adductor canal block or an ultrasound-guided, anesthsiologist-performed adductor canal block. The primary outcome of interest was the time from spinal anesthetic reversal to discharge readiness. 

• The time from anesthetic reversal to discharge was 183.5 minutes (SD 81.2) in the anesthesiologist-performed group, compared to 237.3 minutes (SD 165.7) in the surgeon-performed group.

• There were no significant differences in pain scores at discharge (p=0.19), opioid consumption (p=0.94), readmissions, failure to discharge (p=0.74), functional scores (p>0.05 for all), or quality of life scores (p=0.41).

Bottom line. Surgeon-performed adductor canal blocks are non-inferior to anesthesiologist-performed adductor canal blocks, although the time to discharge is slightly longer.

Read the full ACE Report on this study here.

Peri-operative tranexamic acid (TXA) is now standard practice in total knee arthroplasty protocols around the world because of its ability to reduce intraoperative blood loss.

But if TXA is effective during surgery, an obvious question follows: could extending TXA into the early post-operative period further improve recovery?

A randomized trial presented at AAOS 2026 examined that possibility.

48 patients undergoing primary total knee arthroplasty were randomized to receive either 1.95 g of oral TXA daily from postoperative day 1 through day 3, or placebo. Investigators measured pain scores, range of motion, opioid consumption, and ambulation through 12 weeks after surgery.

One early observation: pain scores on postoperative day one were not significantly different between the two groups.

Looking across the rest of the outcomes begins to clarify whether extending TXA after surgery meaningfully changes recovery — and whether this is a protocol worth reconsidering.

Read the full ACE Report on this study here.

The faculty for the upcoming Spine Surgery Diploma Course continues to grow — bringing together 25 world-class experts who are advancing spine surgery globally. We’re featuring 6 of them here, with more leaders joining this elite program.

This is a true diploma-level experience designed for surgeons who want depth, rigor, and real-world application — delivered through live, interactive sessions with full on-demand access. The program begins April 7, 2026, and enrollment is closing soon. If you’re serious about elevating your spine expertise in 2026, this is your course.

Register now here, and view the full program here.

AAOS 2026: Duloxetine Does Not Reduce Opioid Use Following Total Knee Arthroplasty – In patients undergoing primary total knee arthroplasty, does perioperative duloxetine compared with placebo reduce postoperative opioid consumption and improve pain outcomes following surgery? (Read)

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AAOS 2026: Single-Shot Liposomal Bupivacaine vs. Liposomal Bupivacaine Combined with Dexamethasone – In patients undergoing foot and ankle surgery receiving popliteal and saphenous nerve blocks, does liposomal bupivacaine combined with dexamethasone compared with liposomal bupivacaine alone prolong nerve block duration and reduce postoperative narcotic use within 14 days after surgery? (Read)

AAOS 2026: Kinematic and Mechanical Alignment Result in Similar Outcomes in Total Knee Arthroplasty – In patients undergoing total knee arthroplasty, does kinematic alignment compared with mechanical alignment result in different clinical outcomes, re-operation rates, or patient-reported outcome measures? (Read)

AAOS 2026: Multimodal Pain Protocol vs. Hydrocodone-Acetaminophen After Orthopaedic Trauma Surgery – In patients with isolated orthopaedic injuries undergoing outpatient orthopaedic trauma surgery, does a multimodal pain protocol including ibuprofen, acetaminophen, gabapentin, and oxycodone in addition to a peripheral nerve block, compared with only hydrocodone-acetaminophen with a peripheral nerve block, reduce postoperative opioid consumption measured in morphine milligram equivalents within 14 days after surgery? (Read)

AAOS 2026: Novel Digital Therapeutic for Treatment of Patellofemoral Pain – In patients with chronic patellofemoral pain, does a mobile app–based digital therapeutic program combining exercise therapy and cognitive behavioral therapy compared with standard exercise education and self-directed exercises improve pain and functional outcomes over 12 weeks? (Read)

AAOS 2026: Ascorbic Acid Reduces the Hidden Blood Loss After Total Hip Arthroplasty – In patients undergoing primary total hip arthroplasty, does perioperative intravenous ascorbic acid compared with placebo reduce total and hidden blood loss within 48 hours after surgery? (Read)

AAOS 2026: Impact of Intraosseous Morphine on Pain Control in Primary Total Knee Arthroplasty – In patients undergoing primary total knee arthroplasty, does an intraoperative intraosseous injection of morphine combined with vancomycin compared with vancomycin alone improve postoperative pain control and reduce opioid consumption within 14 days after surgery? (Read)

Thanks for reading!

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