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blood. Degranulation of these platelets releases various growth factors and proteins that promote chondrogenesis, angiogenesis, cell differentiation, proliferation, and remodeling. MSCs are also thought to promote tissue regeneration because of their pluripotent properties. When injected in an area of cartilage damage, MSCs are hypothesized

blood loss. An additional consideration for the anesthesiologist and orthopedic surgeon is managing postoperative pain associated with these procedures. THA and, particularly, TKA, are painful surgical procedures.3 Females are more likely to experience anxiety or depression preoperatively4 and to develop chronic pain syndromes. Effective pain management

blood components. The plasma (containing platelets and antiinflammatory proteins) is then isolated and injected into the joint to theoretically reduce inflammation and attenuate joint destruction.54 Studies have shown variable effectiveness of PRP injections in treating OA pain.55,56 Additionally, there are concerns about cost as these

blood transfusion, operative time >2 h Elective hip or knee joint replacement surgery For Females ONLY - l point Broken hip, pelvis, or leg Current use of birth control or hormone replacement therapy Serious trauma Pregnant or had a baby within the last month Spinal cord injury

blood transfusion and preoperative anemia.82 Hepatitis C The hepatitis C virus (HCV) is the most common chronic bloodborne infection in the United States, and it is estimated that 3.3% of patients undergoing TJA are chronically infected with HCV.104,105 Although these patients account for a small

blood cell transfusion thresholds and storage JAMA 19, 2016;316: 2025-2035 doi:10.1001/jama.2016.9185. 8. Parvizi J, Miller AG & Gandhi K. Multimodal pain management after total joint arthroplasty J Bone Joint Surg Am 11, 2011;93: 1075-1084 doi:10.2106/JBJS.J.01095. 9. Peng

blood transfusion, or took preoperative opioids. Autoimmune arthritis has not been shown to increase the risk for thromboembolic events after TJA, even though patients with RA are usually at increased risk for thromboembolism due Page 32Page 33to chronic inflammation.128 Multiple meta-analyses found no differences

safety concerns due to lack of social acceptance (U.S. Department of Health and Human Services [USDHHS], 2000); a one-and-a-half to two times greater likelihood of lifetime mood and anxiety disorder in a national study (Bostwick, Boyd, Hughes, West, & McCabe, 2014; Meyer, 2003); higher