Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty

Eur J Orthop Surg Traumatol. 2016 Feb;26(2):177-81. doi: 10.1007/s00590-015-1722-2. Epub 2015 Nov 11.


Introduction: The enhanced recovery programme (ERP) is used to improve patient experience before, during and after an operation. Initially designed for colorectal surgery, it has now been adopted by many other disciplines, including orthopaedics. Where applicable, ERP has shown to be associated with less pain, reduced length of hospital stay and increased patient satisfaction in elective orthopaedic procedures. There is, however, a paucity of data regarding the use of ERP in fractured neck of femur (NOF) operations. Our aim was to investigate the effect of ERP on analgesic requirements and hospital length of stay during hemiarthroplasty.

Method: Consecutive notes of 100 patients who received a hemiarthroplasty for a fractured NOF were reviewed retrospectively. In one group (n = 50), patients received routine pre- and post-operative care; the second (n = 50) were on the ERP. All patients were previously mobile with an abbreviated mental test score of more than eight and lived in their own home.

Results: With ERP, oral opiate consumption fell dramatically in the first three post-operative days (4.7 vs. 14.0 mg, p > 0.005). The use of patient-controlled analgesia (PCA) was also significantly reduced (odds ratio 0.16, p > 0.05). Although ERP had no statistically significant effect on length of stay (7 vs. 8.5 days, p = 0.2), it saw a greater proportion of patients being discharged back to their own home (25 vs. 19 patients, p < 0.05).

Conclusion: The ERP reduces post-operative oral opiates and PCA requirements in fractured NOF cases and by inference reduces pain. It does not appear to affect length of hospital stay in an acute unit.

Keywords: Enhanced recovery; Fractured; Hemiarthroplasty; Hip.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use*
  • Arthroplasty, Replacement, Hip / methods
  • Arthroplasty, Replacement, Hip / rehabilitation*
  • Female
  • Hemiarthroplasty / methods
  • Hemiarthroplasty / rehabilitation*
  • Humans
  • Male
  • Pain Management / methods*
  • Pain, Postoperative / drug therapy*
  • Postoperative Care / methods*
  • Retrospective Studies


  • Analgesics, Opioid