This thesis explores several aspects of perioperative care in total knee arthroplasty (TKA), focusing on multimodal pain management and implant fixation techniques. Although TKA effectively improves function and reduces pain in patients with end-stage knee osteoarthritis, up to 20% of patients remain dissatisfied postoperatively.Two studies assessed the role of a sciatic nerve block (SNB) as an adjunct to a femoral nerve block in multimodal analgesia. While the addition of SNB improved early postoperative pain control and reduced opioid consumption, it neither shortened time-to-discharge readiness nor improved long-term functional and pain outcomes. Moreover, its use was associated with motor weakness and may therefore limit fast-track rehabilitation. A prospective cohort study evaluated computer-assisted cryotherapy following TKA. The intervention was found to be safe, with reduced swelling and better early knee flexion. These benefits did not persist at later follow-up intervals or in the other outcomes. It may not offer advantages over conventional cold therapy. Fixation methods were examined through a randomized controlled trial and a long-term retrospective analysis. In a modern implant design, cemented, cementless and hybrid fixation achieved comparable migration and clinical results up to two years after surgery. Long-term data from an older implant design demonstrated superior survival with cemented fixation, particularly in younger and non-inflammatory patients.Collectively, these findings highlight the importance of matching multimodal pain management and fixation strategies to patient characteristics and implant design. Future research should prioritize standardized multimodal pain protocols, long-term follow-up, and a stepwise introduction of emerging technologies in TKA
