***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Recently , a number of studies using intra-articular application of tranexamic acid ( IA-TXA ) , with different dosage and techniques , successfully reduced postoperative blood loss in total knee replacement ( TKR ) . However , best of our knowledge , the very low dose of IA-TXA with drain clamping technique in conventional TKR has not been yet studied . This study aim ed to evaluate the effectiveness and dose-response effect of two low-dose IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction . Methods Between 2010 and 2011 , a triple-blinded r and omized controlled study was conducted in 135 patients undergoing conventional TKR . The patients were allocated into three groups according to intra-articular solution received : Control group ( physiologic saline ) , TXA-250 group ( TXA 250 mg ) , and TXA-500 group ( TXA 500 mg ) . The solution was injected after wound closure followed by drain clamping for 2 hours . Blood loss and transfusion were recorded .  Duplex ultrasound  was performed . Functional outcome and complication were followed for one year . Results There were forty-five patients per groups . The mean total hemoglobin loss was 2.9 g/dL in control group compared with 2.2 g/dL in both TXA groups ( p > 0.001 ) . Ten patients ( 22 % , control ) , six patients ( 13 % , TXA-250 ) and none ( TXA-500 ) required transfusion ( p = 0.005 ) . Thromboembolic events were detected in 7 patients ( 4 controls , 1 TXA-250 , and 2 TXA-500 ) . Functional outcome was non-significant difference between groups . Conclusions Combined low-dose IA-TXA , as 500 mg , with 2-hour clamp drain is effective for reducing postoperative blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or complication . Trial registration Clinical Trials.gov NCT01850394 Background Total knee arthroplasty ( TKA ) is often associated with a severe local inflammatory reaction which , unless controlled , leads to persistent pain up to one year after surgery . St and ard and accelerated rehabilitation protocol s are currently being implemented after TKA , but no consensus exists regarding the long-term effects . Biophysical stimulation with pulsed electromagnetic fields ( PEMFs ) has been demonstrated to exert an anti-inflammatory effect , to promote early functional recovery and to maintain a positive long-term effect in patients undergoing joint arthroscopy . The aim of this study was to evaluate whether PEMFs can be used to limit the pain and enhance patient recovery after TKA . Methods A prospect i ve , r and omized , controlled study in 30 patients undergoing TKA was conducted . Patients were r and omized into experimental PEMFs or a control group . Patients in the experimental group were instructed to use I-ONE stimulator 4hours/day for 60days . Postoperatively , all patients received the same rehabilitation program . Treatment outcome was assessed using the Knee Society Score , SF-36 Health-Survey and VAS . Patients were evaluated pre-operatively and one , two , six and 12 months after TKA . Joint swelling and Non Steroidal Anti Inflammatory Drug ( NSAID ) consumption were recorded . Comparisons between the two groups were carried out using a two-tail heteroschedastic Student ’s t-test . Analysis of variance for each individual subject during the study was performed using ANOVA for multiple comparisons , applied on each group , and a Dunnet post hoc test . A p value < 0.05 was considered statistically significant . Results Pre-operatively , no differences were observed between groups in terms of age , sex , weight , height , Knee-Score , VAS , SF-36 and joint swelling , with the exception of the Functional Score . The Knee-Score , SF-36 and VAS demonstrated significantly positive outcomes in the I-ONE stimulated group compared with the controls at follow-ups . In the I-ONE group , NSAID use was reduced and joint swelling resolution was more rapid than in controls . The effect of I-ONE therapy was maintained after use of the device was discontinued . Conclusions The results of the study show early functional recovery in the I-ONE group . I-ONE therapy should be considered after TKA to prevent the inflammatory reaction elicited by surgery , for pain relief and to speed functional recovery . Trial registration Current Controlled Trials IS RCT OBJECTIVE Continuous femoral nerve block ( CFNB ) , guided by ultrasound combined nerve stimulations , offers advantages for both sides and provides effective postoperative analgesia after total knee arthroplasty ( TKA ) . The objective of this study was to evaluate the medium-term impact of continuous femoral nerve block on knee function and quality of life in patients following TKA . METHODS This was a follow-up study . Total 168 adult patients scheduled for elective TKA were r and omly allocated to receive  postoperative continuous femoral nerve block guided by ultrasound combined nerve stimulator ( group CFNB , n = 82 ) or patient-controlled epidural analgesia ( group PCEA , n = 86 ) . Quality of life , knee function , patient satisfaction , pain medication and associated adverse effects were compared at 1 , 3 , 6 , and 12 months postoperatively . Quality of life was assessed using the Medical Outcomes Study Short Form-36 Health Survey ( MOS SF-36 ) , and clinical results were assessed using the Hospital for Special Surgery ( HSS ) Knee Scoring System . Patient satisfaction scores were divided into four categories . RESULTS A total of 162 patients completed the 12-month follow-up . The CFNB group patients had significantly improved SF-36 scores and physical function at 1 month postoperatively ( P < 0.05 ) ; the remaining seven dimensions were similar between the two groups . No differences were observed at 3 , 6 or 12 months . HSS scores for the four observational time points were comparable . The CFNB group patients reported less pain ; improved knee function , maximum flexion and strength ; less celecoxib consumption and fewer side effects at 1 month than the PCEA group patients . The satisfaction score at 12 months decreased significantly , compared with that at 1 month in both groups ( 3.6 to 2.95 and 3.4 to 2.45 , respectively ) . No difference in satisfaction score was observed between the two groups . CONCLUSIONS Continuous femoral nerve block not only could provide effective postoperative analgesia but also could improve joint function and quality of life in patients at one month postoperatively . Continuous femoral nerve block is a good choice for postoperative analgesia after TKA Purpose Despite the documented blood-saving effects of tranexamic acid ( TNA ) in total knee arthroplasty ( TKA ) , the question whether clinical values of TNA are identical in unilateral and bilateral TKAs remains unclear . This study was undertaken to determine the clinical values of TNA in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol in terms of efficacy ( total blood loss and transfusion rate ) and safety ( the incidences of symptomatic deep vein thrombosis and pulmonary embolism ) . Methods One hundred and eighty unilateral and 146 bilateral TKA patients were r and omized into TNA group or control group . In unilateral TKA patients , TNA ( 10 mg/kg ) was administered intravenously 20 min before tourniquet deflation and repeated 3 h after surgery . In bilateral TKA patients , one more dose ( 10 mg/kg ) was given before tourniquet deflation in the second TKA . A contemporary blood-saving protocol was applied to all patients . The TNA and control groups were compared separately in unilateral and bilateral TKA patients for the efficacy and safety variables . Results In unilateral TKA patients , the TNA group had less total blood loss ( 905 vs. 1,018 mL , p = 0.018 ) than the control group , but there was no difference in the allogenic transfusion rate ( 1 vs. 7 % , n.s . ) . In bilateral TKA patients , the TNA group showed no differences in total blood loss ( 1,282 vs. 1,379 mL , n.s . ) , but a significant reduction in the allogenic transfusion rate ( 7 vs. 27 % , p = 0.002 ) . No symptomatic deep vein thrombosis or pulmonary embolism was found in all patients . Conclusion This study demonstrates that the use of TNA reduces total blood loss , but the effects on the transfusion rate can differ depending on the type of TKAs ( unilateral vs. bilateral ) and the blood-saving protocol s . Level of evidence Therapeutic study , Level I ( double blind r and omized controlled trial ) Introduction The surgical wound of total knee arthroplasty ( TKA ) needs continuous flexion and extension movement . Silicone gel treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching . The aim of this study was to evaluate the clinical efficacy and safety of silicone gel applied to surgical scars of TKA on postoperative scar pain and pruritus . Material s and methods One hundred TKAs were r and omized into a  silicone gel group ( silicone gel was applied to the wound after stitch-out for 1 month ) or a placebo group . The postoperative scar pain and pruritus were evaluated with the use of a visual analog scale ( VAS ) at postoperative 3 months , 6 months and 1 year . Scar assessment was done using the Vancouver scar scale by evaluating scar pigmentation , vascularity , pliability , and height . Results Although silicone gel group showed better pigmentation and height scales than placebo group ( P < 0.05 ) , there were no significant differences in the postoperative scar pain and pruritus VAS scores between the groups ( P > 0.05 ) . Conclusions Application of silicone gel had no beneficial effects on scar pain and itching relief during the early postoperative period of TKA.Level of evidence I-R and omized Controlled Background Postoperative knee swelling is common and impairs early postoperative function following total knee arthroplasty . It was hypothesised that the use of a short-stretch , inelastic compression b and age would reduce knee swelling and improve pain and early function . The aim of this study was to provide preliminary data and test feasibility with a view to informing a larger , future trial . Methods Fifty consecutive patients selected for primary total knee arthroplasty underwent distance r and omisation to receive a short-stretch , inelastic compression b and age or a st and ard wool and crepe b and age for the first 24 h postoperatively .  Study feasibility including recruitment rates , retention rates and complications were analysed . The Oxford Knee Score , the EQ-5D-3L index score , knee swelling , knee range of motion , visual analogue pain score and length of stay were compared between groups . Analysis of covariance ( ANCOVA ) was performed adjusting for the preoperative measurement . Results Sixty-eight percent of eligible patients were recruited into the trial . The retention rate was 88 % . There were no complications regarding compression b and age use . There was a greater mean but non-significant improvement in Oxford Knee Score ( p = 0.580 ; point estimate = 2.1 ; 95 % CI −3.288 to 7.449 ) and EQ-5D-3L index score ( p = 0.057 ; point estimate = 0.147 ; 95 % CI −0.328 to 0.005 ) in the compression b and age group at 6 months . There was no significant difference between groups regarding knee swelling , knee range of motion , visual analogue pain score , complications and length of stay . Conclusion Preliminary data suggests that the use of an inelastic , short-stretch compression b and age following total knee arthroplasty is a safe technique that is acceptable to patients . A larger , multicentre trial is required to determine its effect postoperatively . Trial registration The study was registered with Current Controlled Trials , identifier : IS RCT N86903140 . Registered on 30 May 2013 OBJECTIVES . To evaluate the effectiveness of our new multidisciplinary pathway for total knee replacement patients and compare outcomes after continuous femoral nerve blockade versus conventional patient-controlled analgesia for postoperative pain . DESIGN . R and omised controlled trial in a routine clinical setting . SETTING . Acute orthopaedic wards and operating theatres , Yan Chai Hospital , Hong Kong . PATIENTS . Sixty patients underwent elective unilateral total knee replacement under spinal anaesthesia from May 2009 to September 2011 and were r and omly assigned to  continuous femoral nerve blockade or conventional patient-controlled analgesia ( 30 patients in each group ) . MAIN OUTCOME MEASURES . Quality of pain control was evaluated by pain scores at rest and during mobilisation , opioid consumption , frequency of side-effects , and patient satisfaction score . Rehabilitation progress was assessed according to the day of first starting weight-bearing exercise , day of independent walking in the ward with aid , Timed Up and Go test , and time elapsing till discharge . Surgical outcome was assessed by the Knee Society score 6 months after discharge , re-admissions , and occurrence of complications . RESULTS . Patients having continuous femoral nerve blockade tended to have less pain on movement and achieved earlier mobilisation than those having patient-controlled analgesia . The former group consumed less opioids , had fewer 
    Output:
    
No concerns relating to long-term adverse events were reported .
For a range of treatments there was no evidence linking them with unfavourable pain outcomes .
Conclusions To prevent chronic pain after TKR , several perioperative interventions show benefits and merit further research .
Good- quality studies assessing long-term pain after perioperative interventions are feasible and necessary to ensure that patients with osteoarthritis achieve good long-term outcomes after TKR