Table 1 The strategy of enhanced recovery after primary TKA

Blood Management

Correcting perioperative anemia, including iron supplement, erythropoietin and transfusion.

Multiple TXA application: 5-10 min preoperatively and 3, 6, 12, and 24 hour postoperatively.

Operation: operating carefully and cutting layer by layer.

Pain Management

Preoperative education

Preemptive analgesia: oral Celecoxib preoperatively more than 1 week.

Multimodal analgesia: oral NSAIDs postoperatively 2-4 weeks and 200 mg ropivacaine local infiltration around articular cavity intraoperatively.

Remedy: Opioid.

Nutrition Management

Preoperative early-stage feeding:receiving carbohydrate powder 2 hour and protein powder 6 hour dissolved in normal saline before the induction of anesthesia.

Postoperative diet starting 2–4 hours after surgery.