Enhanced Recovery After Surgery (ERAS)

Part of The Joint Replacement Guide — Phase 5: Recovery and Rehabilitation · Article 29 of 42 · Hip & Knee

Key Points

• ERAS is a structured, evidence-based approach to surgical care spanning from before your operation to after discharge, not just a single step during recovery.
• It has been directly responsible for the shift towards earlier mobilisation and, for many patients, shorter hospital stays.
• ERAS brings together several individual elements covered elsewhere in this guide — optimisation, prehabilitation, anaesthetic choice, and early mobilisation — into one coordinated pathway.
• It is associated with fewer complications, not just faster discharge.

What ERAS Actually Is

Enhanced Recovery After Surgery (ERAS) is not a single treatment but a coordinated, multidisciplinary pathway of care that has been developed and refined over the past two decades across many types of surgery, including hip and knee replacement. Rather than a series of separate decisions made in isolation, ERAS deliberately links together pre-operative optimisation and prehabilitation, anaesthetic technique, pain management, and early, active post-operative mobilisation into a single, evidence-based programme, on the principle that these elements work considerably better together than any one of them does alone.

What It Looks Like in Practice

In practice, an ERAS pathway for joint replacement typically includes clear pre-operative information and goal-setting, the optimisation of modifiable health factors discussed earlier in this guide, minimising fasting time before surgery, a preference for spinal or regional anaesthesia with multimodal pain relief where appropriate, minimising the use of drains and catheters, and — the element patients notice most directly — active encouragement to sit up, stand, and begin walking on the day of surgery itself, rather than waiting until the following day or later.

Why It Matters

The evidence supporting ERAS is genuinely strong and consistent: units that have implemented structured ERAS pathways for joint replacement report reduced complication rates, including lower rates of blood clots and chest infections, alongside shorter average hospital stays. Importantly, this isn’t simply about discharging patients faster for its own sake — earlier mobilisation and reduced hospital stay are themselves associated with fewer complications, since prolonged bed rest and hospital stay carry their own risks, including deconditioning and hospital-acquired infection.

Your Part in ERAS

ERAS depends on active patient participation — it isn’t something done passively to you. Engaging with prehabilitation before surgery, understanding and buying into the plan to mobilise early, and actively participating in your own physiotherapy from day one, all meaningfully improve how well an ERAS pathway works for you individually, tying back to the earlier discussion in this guide about the shared responsibility between you, your family, and your clinical team.

In More Depth

ERAS principles originated in colorectal surgery in the 1990s, developed by researchers who recognised that traditional post-operative care — extended bed rest, prolonged fasting, and delayed mobilisation — was, counterintuitively, contributing to worse outcomes rather than aiding recovery. These principles have since been adapted and validated across many surgical specialties, including orthopaedics, with a substantial body of evidence now specifically supporting their use in hip and knee replacement. The ERAS Society publishes and regularly updates formal, evidence-graded guidelines specific to joint replacement, which many UK units use directly to structure their own local pathways.

This article is general information and does not replace individual clinical advice.

Sources

• ERAS Society — Enhanced Recovery After Surgery guidelines for hip and knee replacement
• Centre for Perioperative Care (CPOC) — enhanced recovery resources
• GIRFT (Getting It Right First Time) — National Report on Orthopaedics

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