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Currently, a popular form of pain control following total knee arthroplasty is the use of periarticular injections; how the medications are injected is a critical step in the efficacy of this modality.

Step 1: Setup

The setup includes the injection fluid and two control syringes with a 22-gauge needle.

Step 2: Inject the Lateral Femoral Periosteum

Inject around the femur before placing the implants.

Step 3: Inject the Posterior Aspect of the Capsule

This is another area of rich innervation that needs to be injected carefully.

Step 4: Inject the Medial Periosteum

Use a similar technique of slow small-volume injections, watching for the periosteal wheal or elevation off the bone.

Step 5: Inject the Capsule and Skin

Include the lateral gutter and proximal extensor mechanism as well as around the patella, with minimal injection into the skin.


Careful injection technique improves the outcome of periarticular injections for pain control.
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John H. Wedge, MD, FRCS(C) responds to:

I would like to thank Mr. Cove for pointing out an obvious typographical error in our manuscript. The vessel described is indeed a branch of the lateral, rather than the medial circumflex femoral a