Update on Current Enhanced Recovery After Surgery (ERAS) Pathways for hip and Knee Arthroplasty

A Review of the Literature

Om V. Patel, MD; Giles R. Scuderi, MD


Curr Orthop Pract. 2022;33(2):178-185. 

In This Article


ERAS pathways are undergoing constant refinement to optimize functional recovery after total hip and knee arthroplasty. Significant advancement has already been made since ERAS was first established by Dr. Henrik Kehlet in the 1990s for colorectal surgery.[77] However, there is still a strong need for well designed, sufficiently powered, RCTs to help identify further interventions in the ERAS pathway. These interventions should further reduce pain, reduce PONV, improve physiologic recovery, and promote quicker functional recovery. Additionally, tools must be developed to predict at-risk patients and gain a better physiologic understanding of the inflammatory response after surgery.[78] Last, emerging technology can be expected to have a substantial influence on ERAS pathways for joint replacement with impacts on preoperative screening and education, surgical procedure, rehabilitation, telehealth visits, and real-time communication.

With strong influence in our current healthcare environment to reduce costs and LOS, interventions must be patient-focused and come from sound, evidence-based recommendations. In the words of Dr. Kehlet,[78] "first better, then faster." The need for further clinical trials and systematic reviews is paramount. This evidence-based update on a few important ERAS components can provide reflection for practitioners utilizing these pathways and provide direction for further research.