An evidence-based review of enhanced recovery after surgery in total knee replacement surgery

Abstract

Enhanced recovery after surgery is gaining popularity among orthopaedic surgeons across the globe and hence a strong evidence base had to be reviewed to make an evidence-based sustainable protocol. Methods The following databases, PubMed, OVID, Cochrane database and EMBASE were searched. The search was limited to 15 components of enhanced recovery after surgery programme which is divided into preoperative, intraoperative and postoperative phases. Inclusion criteria were restricted to articles published in English within the last 15 years and articles comprising of unicompartmental arthroplasty, revision knee arthroplasty, bilateral simultaneous knee arthroplasty and only hip arthroplasty excluded. The full texts were analysed and controversies and limitations of various studies were summarised. Discussion Each component of the programme was thoroughly reviewed and strength and weaknesses of the evidence base summarised. The strength of the evidence was assessed by critically appraising the study methodology and justifying the appropriateness of the inclusion in enhanced recovery after surgery protocol. Conclusion Enhanced recovery after surgery has already been used successfully in various surgical specialities. Enhanced recovery after surgery programmes in knee arthroplasty are yet to be established as a universal practice to be adopted globally. This evidence-based review provides an insight into the best evidence linked to each component and their rationale for inclusion in the proposed enhanced recovery after surgery protocol.

Perioperative management of elderly patients with osteoarthritis requiring total knee arthroplasty

“…Despite its success in improving the quality of life in patients, TKA is associated with considerable acute postoperative pain, which if unrelieved may result in prolonged hospital stay and poorer functional outcomes ( Buvanendran et al 2010 ). Furthermore, elderly patients are usually at higher risk of postoperative medical complications, but these can be avoided by following the enhanced recovery after surgery (ERAS) protocol, which is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery ( Ghosh & Chatterji 2019 ).…”

The primary total knee arthroplasty: a global analysis

“…As the most common treatment for end-stage knee osteoarthritis (OA), TKA played an important part in improving patient-reported outcomes with respect to pain relief, functional restoration, and higher quality of life. Apart from primary OA, some other diagnoses are also the potential underlying indications of TKA, including inflammatory arthritis, fracture (post-traumatic OA and/or deformity), dysplasia, and malignancy [2,3]. Nowadays, the global demand for TKA is increasing at a dramatic rate due to the growing prevalence of knee arthritis.…”

The primary total knee arthroplasty: a global analysis

“…Total knee arthroplasty (TKA) is considered as the most common treatment for end-stage knee osteoarthritis (OA), which also makes great sense for some other underlying indications, including inflammatory arthritis, fracture (post-traumatic OA and/or deformity), dysplasia, and malignancy [1,2]. Contemporary TKA has evolved over the past 50 years since it was first designed at the Hospital for Special Surgery in early 1970s [3].…”