Results of enhanced recovery after surgery (ERAS) for total knee replacement in a Hong Kong public hospital

Background/Purpose Enhanced recovery after surgery (ERAS) for total knee replacement (TKR) is a multi-modal and multi-disciplinary approach designed to enhance patient outcomes. ERAS was first introduced in 1997 and further refined with published guidelines for TKR in 2020. Our institute has been adopting ERAS for TKR since 2017. This study aimed to outline our local ERAS protocol for TKR and assess its outcomes in terms of length of stay (LOS). Methods A retrospective cohort study was carried out comparing total knee arthroplasty patients treated by ERAS (2021–2023) with conventional cohort (2013–2016). Data from pre-operative, immediate after TKR, and 3 months post-TKR were collected through clinical and medical records through hospital electronic record system. Results A total of 1283 patients who underwent TKR (708 patients in ERAS group and 575 in conventional group) were recruited. Both median pre-operative (0.00 vs 1.00 day; P < 0.001) and total LOS (6.00 vs 8.00 days; P < 0.001) were significantly reduced in the ERAS group. Mean interval between hospital admission and surgery was significantly shorter in the ERAS group (0.01 months) compared to the conventional group (0.04 months) ( P = 0.049). Notable higher proportion of conventional group underwent surgery without navigation was reported (13.0% vs 1.4%, P < 0.001). In terms of deep vein thrombosis (DVT) prophylaxis, Pradaxa was predominantly prescribed in the ERAS group (83.7%), while Clexane was more commonly used in the conventional group (56.9%). Regarding the type of anaesthesia, percentage of patients who received spinal anaesthesia was significantly higher in the ERAS group than the conventional group (87.3% vs 76.9%; P < 0.001). In a step-wise linear regression analysis, applying ERAS remained a statistically significant predictor for a reduced LOS ( r 2 = 0.064; coefficient (95% confidence interval) = −1.01 (−1.89, −0.13); P = 0.024) after controlling for surgical side, using navigation, DVT prophylaxis and anaesthesia. Conclusions After implementation of ERAS in patients after TKR, length of hospital stay was significantly decreased, with or without using navigation, the choice of DVT prophylaxis or choice of anaesthesia. Further investigations were warranted to implement a multi-centre large-scale long-term study to explore long-term outcomes and quality-of-life measures post-TKR.