The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis. The included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low. A low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

This study aimed to determine the effects of heat acclimatization on performance and pacing during outdoor cycling time trials (TT, 43.4 km) in the heat. Nine cyclists performed three TT in hot ambient conditions (TTH, approximately 37°C) on the first (TTH-1), sixth (TTH-2), and 14th (TTH-3) days of training in the heat. Data were compared with the average of two TT in cool condition (approximately 8°C) performed before and after heat acclimatization (TTC). TTH-1 (77 ± 6 min) was slower (P = 0.001) than TTH-2 (69 ± 5 min), and both were slower (P < 0.01) than TTC and TTH-3 (66 ± 3 and 66 ± 4 min, respectively), without differences between TTC and TTH-3 (P > 0.05). The cyclists initiated the first 20% of all TT at a similar power output, irrespective of climate and acclimatization status; however, during TTH-1, they subsequently had a marked decrease in power output, which was partly attenuated after 6 d of acclimatization and was further reduced after 14 d. HR was higher during the first 20% of TTH-1 than that in the other TT (P < 0.05), but there were no differences between conditions from 30% onward. Final rectal temperature was similar in all TTH (40.2°C ± 0.4°C, P = 1.000) and higher than that in TTC (38.5°C ± 0.6°C, P < 0.001). After 2 wk of acclimatization, trained cyclists are capable of completing a prolonged TT in a similar time in the heat compared with cool conditions, whereas in the unacclimatized state, they experienced a marked decrease in power output during the TTH.

Blunted muscle hypertrophy and impaired regeneration with aging have been partly attributed to satellite cell (SC) dysfunction. However, true muscle regeneration has not yet been studied in elderly individuals. To investigate this, muscle injury was induced by 200 electrically stimulated (ES) eccentric contractions of the vastus lateralis (VL) of one leg in seven young (20‐31 years) and 19 elderly men (60‐73 years). This was followed by 13 weeks of resistance training (RT) for both legs to investigate the capacity for hypertrophy. Muscle biopsies were collected Pre‐ and Post‐RT, and 9 days after ES, for immunohistochemistry and RT‐PCR. Hypertrophy was assessed by MRI, DEXA, and immunohistochemistry. Overall, surprisingly comparable responses were observed between the young and elderly. Nine days after ES, Pax7+ SC number had doubled ( P < .05), alongside necrosis and substantial changes in expression of genes related to matrix, myogenesis, and innervation ( P < .05). Post‐RT, VL cross‐sectional area had increased in both legs (~15%, P < .05) and SCs/type II fiber had increased ~2‐4 times more with ES+RT vs RT alone ( P < .001). Together these novel findings demonstrate “youthful” regeneration and hypertrophy responses in human elderly muscle. Furthermore, boosting SC availability in healthy elderly men does not enhance the subsequent muscle hypertrophy response to RT.