Enhanced recovery protocols in total hip and knee arthroplasty: what are the recent trends

Abstract

Perioperative management of hip and knee arthroplasty patients has evolved significantly over the past few years, almost hand in hand with the advancement of the surgical technique itself. The notion of enhanced recovery protocol is rapidly being accepted by various establishments to reduce the hospital stay and perioperative morbidity. It consists of application of aggressive perioperative interventions aiming for a speedy recovery with least complications, while maintaining good patient care. We reviewed various published articles to understand the importance of each of these interventions. Components that showed improvement in the outcomes were patient education and counselling, pre-operative supplementation to improve wound healing and reduce length of hospital stay. Intra-operative use tranexamic acid and avoidance of drains reduce operative blood loss and subsequent transfusion. Multimodal analgesia, early mobilization with pharmacological and mechanical prophylaxis to reduce venous thromboembolism showed a positive correlation with rapid recovery.