Implementation of an ERAS® Programme for Total Hip and Knee Arthroplasty in a High-Volume University Hospital

TL;DR

This paper describes the successful implementation of an ERAS program for hip and knee surgeries in a high-volume hospital, improving compliance and patient care.

Contribution

The study demonstrates the feasibility of implementing an ERAS® program in orthopaedic surgery with multidisciplinary support and iterative feedback.

Findings

An ERAS program for THA and TKA was successfully implemented with 81% compliance after four seminars.

Certification was achieved in June 2023 following a structured three-phase implementation.

Multidisciplinary teamwork and data collection were critical for program success.

Abstract

Background. Enhanced Recovery After Surgery (ERAS) is a structured, multidisciplinary programme designed to optimise the entire perioperative pathway through evidence-based, patient-centred, standardised care. The objective of this report is to determine whether it is feasible to implement an ERAS® program in orthopaedic surgery within our institution for primary THA and TKA. Methods. This single-centre quality-improvement project followed the ERAS® Society certification framework to create and implement an enhanced-recovery pathway for primary total hip and knee arthroplasty. The three-phase roadmap comprised baseline pathway mapping and audit, pilot implementation and refinement, and full roll-out, punctuated by four multidisciplinary seminars. Key aspects of this programme included preoperative education, minimal fasting and early return to feeding, rational choice of regional anaesthesia techniques, administration of multimodal analgesia, reduction in urinary and surgical catheterization, active management of the risk of blood loss and deep vein thrombosis, optimisation of surgical workflow and techniques, and early mobilisation of patients. Global- and element-level compliance was tracked prospectively; ≥70% compliance was required for certification. External ERAS® Society review at month 15 confirmed data integrity, sustainability planning, and successful certification. Continuous feedback loops drove micro-teaching and order-set optimisation throughout deployment phases. Results. Our ERAS programme for primary THA and TKA was introduced in April 2022. The definitive programme contained 24 mandatory elements grouped into three perioperative areas. After the fourth seminar, the rate of compliance was 81%. The certification was obtained in June 2023. Conclusions. Implementing an ERAS® programme for primary total hip and knee arthroplasty is feasible within a high-volume academic institution when supported by multidisciplinary teamwork, robust data collection, and iterative feedback mechanisms. Further high-quality outcome-focused research is required to evaluate the clinical impact of individual ERAS components and to validate a personalised ERAS programme incorporating emerging technologies.