Another popular injection combination includes a deep and superficial mixture in TKA. In their study, this intra-articular injection provided the same pain relief as patient-controlled epidural anesthesia with FNB (Meftah et al. 2012):

Deep intraoperative injection

Superficial intraoperative injection

In a recent prospective, multicenter study, pain and satisfaction were investigated in 424 patients undergoing TKA by 15 surgeons in 14 hospitals. Combining intra-articular injections with nerve blocks provided the best pain relief for the first 48 h, and these modalities with epidural anesthesia yielded higher patient satisfaction at 2 weeks after surgery (Chang and Cho 2012). Interestingly, one recent investigation of posterior approach THA with regional anesthesia found no improvement for patients receiving periarticular local anesthetic in regard to postoperative pain, length of hospital stay, or mobility (Dobie et al. 2012). An injection of a new drug with liposome-encapsulated bupivacaine may deliver local anesthesia to the tissues for 96 h (Exparel 2014). This is a drug with theoretical benefits but no published studies yet for TJA.

The patient’s own centrifuged blood to create platelet-rich plasma (PRP) has been used on and in joint replacement incisions to potentially improve healing. However, one recent study shows no difference in total knee arthroplasties treated with PRP in regard to blood loss, passive range of motion, narcotic requirement, or length of hospital stay (DiIorio et al. 2012).