An evidence-based review of enhanced recovery interventions in knee replacement surgery

Ann R Coll Surg Engl. 2013 Sep;95(6):386-9. doi: 10.1308/003588413X13629960046435.


Introduction: Total knee replacement (TKR) is a very common surgical procedure. Improved pain management techniques, surgical practices and the introduction of novel interventions have enhanced the patient's postoperative experience after TKR. Safe, efficient pathways are needed to address the increasing need for knee arthroplasty in the UK. Enhanced recovery programmes can help to reduce hospital stays following knee replacements while maintaining patient safety and satisfaction. This review outlines common evidence-based pre, intra and postoperative interventions in use in enhanced recovery protocols following TKR.

Methods: A thorough literature search of the electronic healthcare databases (MEDLINE(®), Embase™ and the Cochrane Library) was conducted to identify articles and studies concerned with enhanced recovery and fast track pathways for TKR.

Results: A literature review revealed several non-operative and operative interventions that are effective in enhanced recovery following TKR including preoperative patient education, pre-emptive and local infiltration analgesia, preoperative nutrition, neuromuscular electrical stimulation, pulsed electromagnetic fields, perioperative rehabilitation, modern wound dressings, different standard surgical techniques, minimally invasive surgery and computer assisted surgery.

Conclusions: Enhanced recovery programmes require a multidisciplinary team of dedicated professionals, principally involving preoperative education, multimodal pain control and accelerated rehabilitation; this will be boosted if combined with minimally invasive surgery. The current economic climate and restricted healthcare budget further necessitate brief hospitalisation while minimising costs. These non-operative interventions are the way forward to achieve such requirements.

Publication types

  • Review

MeSH terms

  • Analgesia / methods
  • Arthralgia / rehabilitation
  • Arthralgia / surgery*
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Electric Stimulation Therapy / methods
  • Humans
  • Length of Stay
  • Nutrition Assessment
  • Perioperative Care / methods*
  • Physical Therapy Modalities
  • Recovery of Function
  • Surgery, Computer-Assisted / methods
  • Surgery, Computer-Assisted / rehabilitation
  • Surgical Wound Infection / prevention & control