Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty.

Stephen Davies, Amanda H Kumar, Stuart A Grant, Jeff Gadsden

Journal: Anesthesiology clinics 2025;43(4):659-671

PMID: 41233101

Abstract

Over 800,000 total knee arthroplasties (TKAs) are performed annually in the United States, with costs exceeding $18 billion. As the prevalence of knee osteoarthritis rises, enhanced recovery after surgery (ERAS) protocols have become vital to improve outcomes and reduce costs. ERAS in TKA focuses on optimizing pain control, minimizing hospital stays, and reducing complications. Key preoperative interventions include correcting anemia, improving nutritional status, encouraging smoking cessation, and cautiously evaluating carbohydrate loading. These measures have been shown to lower transfusion rates, reduce perioperative complications, and improve recovery. This review outlines the evidence supporting ERAS strategies tailored to orthopedic patients undergoing TKA.

Address: Regional Anesthesiology and Acute Pain Medicine, Duke University Medical Center, Durham, NC, USA.; Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.; Department of Anesthesiology, University of North Carolina School of Medicine, Durham, NC, USA.; Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. Electronic address: [email protected].

DOI: 10.1016/j.anclin.2025.07.006

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MeSH Terms: Humans, Arthroplasty, Replacement, Knee, Enhanced Recovery After Surgery, Postoperative Complications, Perioperative Care