Enhanced recovery pathways improve early outcomes and reduce length of stay in primary hip and knee arthroplasty: A systematic review of randomized controlled trials

Abstract

Background

Enhanced Recovery After Surgery (ERAS) protocols represent an evidence-based approach to perioperative care, though evidence from randomized controlled trials in primary hip and knee arthroplasty remains limited.

Objective

This systematic review aims to synthesize evidence from randomized controlled trials (RCTs) comparing ERAS protocols with standard care for primary hip and knee arthroplasty.

Methods

Four databases were searched following PRISMA guidelines. RCTs comparing ERAS protocols with standard care for primary hip or knee arthroplasty were included. Primary outcome was length of stay (LOS), with secondary outcomes including patient-reported outcomes, functional measures, and complications.

Results

Five RCTs (710 patients) met inclusion criteria. ERAS pathways reduced LOS by an average of 4.7 days compared to standard care. Patients in ERAS protocols demonstrated superior early functional recovery, particularly in the first postoperative week, with improved performance in mobility tests and daily activities. Patient-reported outcomes generally favoured ERAS protocols, though measurement heterogeneity limited synthesis. No studies reported increased complications with ERAS implementation. The role of multidisciplinary teams, particularly nurse coordinators, was identified as an important for protocol success.

Conclusion

This systematic review of RCTs provides strong evidence that ERAS pathways reduce length of stay following primary hip and knee arthroplasty without compromising patient outcomes or safety. While ERAS protocols were associated with improved early functional recovery, heterogeneity in assessment methods limits definitive conclusions.