Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4,500 consecutive procedures

Acta Orthop. 2013 Feb;84(1):40-3. doi: 10.3109/17453674.2013.771298. Epub 2013 Jan 31.


Background and purpose: Our unit started to use routine multimodal techniques to enhance recovery for hip and knee arthroplasty in 2008. We have previously reported earlier discharge, a trend toward a reduction in complications, and a statistically significant reduction in mortality up to 90 days after surgery. In this study, we evaluated the same cohort to determine whether survival benefits were maintained at 2 years.

Patients and methods: We prospectively evaluated 4,500 unselected consecutive total hip and knee replacements. The first 3,000 underwent a traditional protocol (TRAD) and the later 1,500 underwent an enhanced recovery protocol (ER). Mortality data were collected from the Office of National Statistics (UK).

Results: There was a difference in death rate at 2 years (TRAD vs. ER: 3.8% vs. 2.7%; p = 0.05). Survival probability up to 3.7 years post surgery was significantly better in patients who underwent an ER protocol.

Interpretation: This large prospective case series of unselected consecutive patients showed a reduction in mortality rate at 2 years following elective lower-limb hip and knee arthroplasty following the introduction of a multimodal enhanced recovery protocol. This survival benefit supports the routine use of an enhanced recovery program for hip and knee arthroplasty.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / mortality
  • Arthroplasty, Replacement, Hip / rehabilitation*
  • Arthroplasty, Replacement, Knee / mortality
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Cause of Death
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Prospective Studies
  • Survival Analysis
  • Treatment Outcome
  • United Kingdom / epidemiology