Enhanced Recovery after Surgery (ERAS) for Hip and Knee Replacement—Why and How It Should Be Implemented Following the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ERAS protocols are multi-modal, and every component is vital to minimise the surgical stress response. The focus should be on providing better and not just faster care. Units should learn from the past in order to expedite the implementation of or adaption of existing ERAS protocols. Strong leadership will be required, along with a supportive organisational culture, an inter-professional approach, and a recognised QI method should be used to contextualize improvement efforts.

Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty

“…There has been evidence suggesting that real-time virtual rehabilitation may be equivalent to conventional methods for adherence, improvement of function and relief of pain seen in these conditions [ 46 ]. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation and the use of telemedicine to complete outpatient appointments may be utilized [ 81 ]. We are aware that the telerehabilitation program is a wide area of improvement for current posthospital patient care process in Poland.…”

Physiotherapy in an advanced rehabilitation pathway for patients after hip and knee arthroplasty: A proposal

“…Hip and knee arthroplasties have become the answer for optimal function and quality of life. Using an ARP pathway in hip and knee arthroplasty surgeries on patients waiting for elective surgeries may decrease the already long waiting lists (Wainwright 2021) in the public sector and address the backlog in the private sector in SA.…”

Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty

“…An emphasis on short hospital stays is natural at this point 9,10 . The resumption of surgery after the peak of COVID-19 "represented an opportunity for facilities to reset their clinical pathway towards outpatient surgery to maximize resources" 9 for knee arthroplasty surgery. Owing to COVID-19 and movement toward pay for performance models, the surgical world continues to look for the best practices to adapt.…”