Enhanced recovery pathways reduce length of stay and improve outcomes in hip and knee arthroplasty

Aim: <br/>To synthesize evidence from randomized controlled trials (RCTs) comparing Enhanced Recovery After Surgery (ERAS) protocols with standard care for primary hip and knee arthroplasty. <br/><br/>Design: <br/>Systematic review of randomized controlled trials. <br/><br/>Method: <br/>A comprehensive search of four databases identified RCTs comparing enhanced <br/>recovery pathways with standard care in hip and knee arthroplasty. Primary outcome was length of stay, with secondary outcomes including patient-reported outcomes, functional measures, and complications. Assessment of methodological quality was performed using the Cochrane risk-of-bias tool. Narrative and tabular synthesis was utilised for all individual studies and comparisons between ERAS and standard care pathways were grouped and reported on. <br/><br/>Results: <br/>Five RCTs (710 patients) met inclusion criteria. ERAS pathways reduced length of by an average of 4.7 days compared to standard care. Patients in ERAS protocols <br/>demonstrated superior early functional recovery, particularly in the first postoperative week, with improved performance in mobility tests and daily activities. Patient-reported outcomes generally favored ERAS protocols, though measurement heterogeneity limited synthesis. No studies reported increased complications with ERAS implementation. <br/><br/>Conclusion: <br/>ERAS pathways significantly reduce length of stay following primary hip and knee arthroplasty while improving early functional recovery and without compromising patient safety. While early functional benefits were evident, standardisation of outcome measures is needed to improve comparability across studies. <br/><br/>Key practice points <br/>• Enhanced recovery pathways reduce hospital length of stay without increasing <br/>complications. <br/>• Early postoperative mobility and function are improved with enhanced recovery. <br/>• Further research is needed to refine protocols and standardise outcome <br/>measures.