Enhanced recovery after surgery (ERAS) in Hip and Knee replacements

The concept of Early recovery after surgery was pioneered in the 1990s. The hypothesis is that the stress associated with surgery to the body in combination with chemical changes and prolonged immobilisation influences outcomes negatively.
Therefore, addressing multiple factors to minimise the surgical insult should impact outcome at least in the short term.

At the clinic, these principles are applied to all surgical procedures, particularly major surgery like hip and knee replacement. Some examples include:

Anaesthesia

This includes the use of pre operative metabolic stress reducing agents and modification to the anaesthetic regimen, led by a procedural pain specialist and our team of experienced anaesthetists. Their aim is to minimise discomfort associated with surgery as well as the common side effects of pain medications such as drowsiness and nausea. These two side effects in particular are the main hurdles to immediate recovery of function after surgery.

Multimodal Analgesia (MMA)
Intraoperative and post operative use of multimodal analgesia. This includes the use of a combination of local anaesthetic infiltration with synthetic opioids and minimising traditional opioid use both during and after the operation as opioids (morphine etc) are associated with a significant undesirable side effect profile.

Surgical technique

Emphasising minimal trauma and maximal preservation of as much of the of soft tissue envelope as possible should also reduce the insult of surgery and, in turn, positively affect recovery. In hip replacements, SuperPATH is the least invasive and most preserving surgical technique when considering the soft tissue envelope. In knee replacements, various techniques and implant designs have been claimed to make difference. Some of these are explicable whereas others are simply anecdote.

Early Mobilisation

It appears that early mobilisation after surgery has very positive influence on recovery as well as complication profile. The main hurdle to early mobilisation is drowsiness and nausea. With above discussed modalities the aim is to reduce these very side effects. At the clinic, we aim to get ALL joint replacement patients up walking the same day as their surgery thereby giving them an early start on their functional recovery.

Individual recovery patterns may vary and be influenced by various factors however, in most patients, short term recovery can be very quick. The following videos are aimed at giving patients an idea of what most people are like at different stages of recovery after their knee/ hip replacement.