Title : Implementation of an Enhanced Recovery After Surgery (ERAS) pathway for primary hip and knee arthroplasty
Abstract:
Background: Enhanced Recovery After Surgery (ERAS) pathways have consistently demonstrated reductions in hospital Length of Stay (LOS), complications, and healthcare costs while improving patient outcomes following primary hip and knee arthroplasty. Despite strong evidence and national guidance supporting ERAS implementation, variation in perioperative care remains. This audit aimed to establish baseline performance within our elective orthopaedic unit, identify factors contributing to delayed discharge, and inform the development of a local ERAS pathway.
Methods: A retrospective audit was undertaken of all elective primary hip and knee arthroplasty patients admitted to a dedicated elective orthopaedic ward during December 2025. Patient demographics, American Society of Anaesthesiologists (ASA) grade, procedure type, Total Length of Stay (TLOS), physiotherapy and medical reviews, postoperative investigations, mobilisation, discharge milestones, complications and readmissions were collected using a standardised data collection tool. Patients with a TLOS greater than two days were analysed to identify primary causes of discharge delay.
Results: The cohort had a mean age of 68 years; 62% were male, 38% female. Procedures comprised 53% total hip replacements (THR), 46% Total Knee Replacements (TKR) and 1% Unicompartmental Knee Replacements (UKR). The overall mean LOS was 3.3 days. Nearly all patients (99%) were mobilised on postoperative day one. Delays in postoperative blood tests occurred in 7% of patients, while delays in postoperative radiography affected 37%. Patients required a mean of 3.4 physiotherapy reviews and 2.3 medical reviews prior to discharge. The principal factors contributing to prolonged admission were postoperative medical or surgical complications, therapy-related delays, and discharge processes including completion of paperwork. Four patients were readmitted with wound complications, one with hip dislocation, and one delayed hip dislocation was identified during outpatient follow-up. Overall, 84% of patients reported satisfaction with their new joint.
Conclusion: This baseline audit identified several modifiable factors contributing to prolonged hospital stay following primary arthroplasty. The findings support implementation of a multidisciplinary ERAS pathway focusing on earlier mobilisation, streamlined discharge processes, and optimisation of therapy resources. A pilot ERAS programme with prospective re-audit is planned to evaluate its impact on length of stay, patient outcomes, and service efficiency.
