Total knee replacement (TKR) and total hip replacement (THR) can provide pain relief and restoration of function in individuals with musculoskeletal impairment. The procedures are extremely successful and essentially unrivaled in the treatment of osteoarthritis pain. Demand is expected to increase. Because of these factors, a detailed understanding of perioperative issues in THR and TKR is important to practitioners. Issues include nonoperative measures and pharmacologic strategies. The discussion of pharmacology in joint replacement before, during, and after surgery includes multimodal management and agents such as acetaminophen, nonsteroidal antiinflammatory agents, injections of cortisone or viscosupplementation, and tramadol.
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