An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom--follow up at one year

Knee. 2012 Oct;19(5):525-9. doi: 10.1016/j.knee.2011.07.012. Epub 2011 Aug 30.


The concepts of Enhanced Recovery Programmes (ERP) are to reduce peri-operative morbidity whilst accelerating patient's rehabilitation resulting in a shortened hospital stay following primary joint arthroplasty. These programmes should include all patients undergoing surgery and should not be selective. We report a consecutive series of 1081 primary total knee arthroplasties undergoing an enhanced recovery programme with a one year follow up period. A comparative cohort of 735 patients from immediately prior to the enhanced recovery programme implementation was also reviewed. The median day of discharge home was reduced from post-operative day six to day four (p<0.001) for the ERP group. Post-operative urinary catheterisation (35% vs. 6.9%) and blood transfusion (3.7% vs. 0.6%) rates were significantly reduced (p<0.001). Within the ERP group median pain scores (0 = no pain, 10 = maximal pain) on mobilisation were three throughout hospital stay with 95% of patients ambulating within 24h. No statistical difference was found in post-operative thrombolytic events (p=0.35 and 0.5), infection (p=0.86), mortality rates (p=0.8) and Oxford Knee Scores (p=0.99) at follow up. This multidisciplinary approach provided satisfactory post-operative analgesia allowing early safe ambulation and expedited discharge to home with no detriment to continuing rehabilitation, infection or complication rates at one year.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Early Ambulation
  • Female
  • Follow-Up Studies
  • Humans
  • Knee Joint / physiology*
  • Length of Stay
  • Male
  • Pain, Postoperative / rehabilitation*
  • Patient Discharge
  • Postoperative Period
  • Program Evaluation*
  • Range of Motion, Articular / physiology*
  • Recovery of Function*
  • Retrospective Studies
  • Time Factors
  • United Kingdom