Assessment of enhanced recovery after surgery protocol in older adults undergoing total knee arthroplasty

This study aimed to examine the influence of enhanced recovery after surgery (ERAS) application on postoperative recovery dynamics and safety profiles in elderly total knee arthroplasty (TKA) patients. A retrospective cohort analysis was performed on 400 individuals aged 65 years or older who underwent primary unilateral TKA between January 2022 and December 2023. According to perioperative management strategies, participants were divided into an ERAS group (n = 200) managed with a standardized multimodal care pathway and a conventional group (n = 200) receiving routine treatment. Comparative evaluations included perioperative parameters such as time to first ambulation, hospital stay duration (length of stay), pain intensity measured by the visual analog scale, knee range of motion at discharge, postoperative complication incidence, and overall patient satisfaction. No significant differences were found in baseline demographic or comorbidity profiles between the 2 cohorts (P >.05). Compared with the conventional management pathway, ERAS implementation was associated with a significantly shorter length of stay (6.20 ± 1.80 vs 9.50 ± 2.30 days, P <.001), earlier mobilization (1.60 ± 0.50 vs 2.80 ± 0.90 days, P <.001), lower visual analog scale pain scores on postoperative days 1 and 3 (both P <.001), and greater knee flexion at discharge (105.30 ± 9.40° vs 92.60 ± 10.80°, P <.001). Although the overall complication rate was numerically lower in the ERAS group (6.0% vs 8.5%, P = .358), the difference was not statistically significant. Notably, patient satisfaction markedly improved in the ERAS cohort (92.5% vs 78.0%, P = .001). Implementation of the ERAS pathway in elderly patients undergoing TKA significantly enhances postoperative functional recovery, reduces pain, and increases satisfaction while maintaining a comparable safety profile. These findings support ERAS as a reliable, multidisciplinary, and cost-effective perioperative management strategy for geriatric TKA care. These findings suggest potential clinical and healthcare efficiency benefits; however, formal economic evaluations are required to confirm cost-effectiveness.