Optimizing perioperative management of total joint arthroplasty.

Clinical pathways for total joint arthroplasty have been shown to reduce costs and significantly impact perioperative outcomes mainly through reducing provider variability. Effective clinical pathways link evidence to individual practice and balance costs with local experience, outcomes, and access to resources for responsible perioperative management. Common components of clinical pathways with major impact on perioperative outcomes are: 1) implementing pathways designed to include multimodal analgesia with regional anesthesia, 2) use of tranexamic acid to reduce blood loss, and 3) preconditioning followed by participation in early, accelerated rehabilitation programs to prevent postoperative complications related to immobility.