Enhanced recovery after surgery protocol improves postoperative pain and shortens length of stay among patients undergoing primary total knee arthroplasty

Background: Enhanced Recovery After Surgery (ERAS) is a "fast-track", perioperative, multi-disciplinary concept aimed at improving recovery time and reducing length of hospital stay.Objective: This study aims to compare the postoperative outcomes of ERAS versus non-ERAS Total Knee Arthroplasty (TKA), with the primary outcomes being day 0 pain score, days 1-2 range of motion (ROM), days 1-2 distance walked and hospital length of stay (LOS).Methods: A retrospective analysis was performed for 111 consecutive patients who had undergone primary unilateral TKA from November 2019 to October 2020 at a single tertiary hospital by fellowship-trained arthroplasty surgeons. Three independent, blinded observers extracted patient data from our institution's Electronic Medical Records. The ERAS protocol included preoperative smoking and alcohol cessation, preoperative physiotherapy, intraoperative local infiltration analgesia using a drug cocktail, postoperative multimodal analgesia and postoperative day 0 physiotherapy, while any patient who deviated from any step were classified as non-ERAS. Two-sample t-tests, Wilcoxon rank-sum tests and Chi-squared tests were used to compare the outcome variables between ERAS and non-ERAS patients.Results: Patients under the ERAS protocol (n = 67) reported a significantly lower postoperative day 0 pain score (p = .0480) and a shorter hospital LOS (p = .0189) than non-ERAS patients (n = 44). No significant difference (p > .05) was observed for ROM and distance walked on days 1-2.Conclusion: Our study demonstrates that the ERAS protocol improves day 0 postoperative pain and shortens hospital LOS while being non-inferior for ROM and distance walked on days 1-2.