Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty

Stephen Davies; Amanda H Kumar; Stuart A Grant; Jeff Gadsden

doi:10.1016/j.anclin.2025.07.006

Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty

Anesthesiol Clin. 2025 Dec;43(4):659-671. doi: 10.1016/j.anclin.2025.07.006. Epub 2025 Sep 4.

Authors

Stephen Davies¹, Amanda H Kumar², Stuart A Grant³, Jeff Gadsden⁴

Affiliations

¹ Regional Anesthesiology and Acute Pain Medicine, Duke University Medical Center, Durham, NC, USA.
² Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
³ Department of Anesthesiology, University of North Carolina School of Medicine, Durham, NC, USA.
⁴ Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. Electronic address: Jeff.gadsden@duke.edu.

PMID: 41233101
DOI: 10.1016/j.anclin.2025.07.006

Abstract

Over 800,000 total knee arthroplasties (TKAs) are performed annually in the United States, with costs exceeding $18 billion. As the prevalence of knee osteoarthritis rises, enhanced recovery after surgery (ERAS) protocols have become vital to improve outcomes and reduce costs. ERAS in TKA focuses on optimizing pain control, minimizing hospital stays, and reducing complications. Key preoperative interventions include correcting anemia, improving nutritional status, encouraging smoking cessation, and cautiously evaluating carbohydrate loading. These measures have been shown to lower transfusion rates, reduce perioperative complications, and improve recovery. This review outlines the evidence supporting ERAS strategies tailored to orthopedic patients undergoing TKA.

Keywords: Enhanced recovery pathway; TKA; Total knee arthroplasty.

Publication types

Review

MeSH terms

Arthroplasty, Replacement, Knee* / methods
Enhanced Recovery After Surgery*
Humans
Perioperative Care / methods
Postoperative Complications / prevention & control