Enhanced recovery programmes can reduce length of stay after total knee replacement without sacrificing functional outcome at one year

Ann R Coll Surg Engl. 2015 Nov;97(8):563-7. doi: 10.1308/rcsann.2015.0016. Epub 2015 Oct 13.


Introduction: Enhanced recovery programmes (ERPs) are being widely adopted in total knee replacement (TKR) procedures but studies confirming that they have no adverse effects on functional outcomes are lacking. The aim of this study was to compare length of stay, postoperative functional outcome and range of motion at one year postoperatively between patients undergoing TKR with an ERP and those with traditional rehabilitation.

Methods: A total of 165 consecutive patients undergoing primary unilateral TKR were included in the study. Overall, 84 patients undergoing TKR with an ERP were compared with a series of 81 patients undergoing primary unilateral TKR with traditional rehabilitation, immediately before the introduction of the ERP.

Results: The median postoperative length of stay was 3 days in the ERP cohort and 4 in the traditionally rehabilitated cohort (p<0.001). There were no significant differences in the preintervention characteristics of the groups and there was no significant difference in operative time, transfusion or rates of manipulation under anaesthesia. There was no difference in magnitude of improvement in American Knee Society score (p=0.12) or range of motion (p=0.81) between the groups.

Conclusions: ERP can reduce length of stay after TKR while offering improvements in knee function equivalent to those experienced by patients undergoing TKR with traditional rehabilitation. Furthermore, ERP can be implemented successfully in the setting of a district general hospital.

Keywords: Enhanced recovery; Fast track; Total knee replacement.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Disease Management*
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay / trends
  • Male
  • Osteoarthritis, Knee / physiopathology*
  • Osteoarthritis, Knee / rehabilitation
  • Osteoarthritis, Knee / surgery
  • Postoperative Period
  • Range of Motion, Articular / physiology*
  • Recovery of Function*
  • Time Factors