Enhanced recovery for lower limb arthroplasty

performed more than 140 000 knee and hip arthroplasties in England and Wales. An increas-ingly elderly population and increasing levels of obesity indicate that these numbers are likely to increase. Orthopaedic teams have looked at the lessons learned from ‘fast track ’ colorectal surgery and applied the principles to enhanced recovery for lower limb arthroplasty procedures. Enhanced recovery/fast-track surgery Fast-track surgery or more appropriately named enhanced recovery refers to a multidisciplinary, evidence-based, and procedure-specific strategy to surgery. Early work on enhanced recovery was pioneered by Henrik Kehlet, a Danish surgeon in 1990. The strategy has four strands: improving preoperative care, reducing the physical stress of the operation, and decreasing postoperative discomfort, thereby leading to improved post-operative mobility and earlier supported dis-charge. These are all targeted by the ERAS (enhanced recovery after surgery) team (anaesthe-tists, surgeons, physiotherapists, and nurses) allowing faster recovery with better outcomes. There are a number of potential advantages to this approach, including standardized care, earlier discharge, increased patient satisfaction, and reduced morbidity and potentially mortality.1 In the UK, a nationwide ERAS network has developed with workshops and online forums. ‘Flagship ’ centres have government support to provide observational visits and follow-up support to allow other centres to set up their own enhanced recovery programmes. The recent pub-lication from the Department of Health ‘Delivering Enhanced Recovery ’ provides a basis for these processes.2 However, there is no single protocol for all hospitals and each centre must develop its own ERAS programme based on its own strengths and limitations. The Golde