ERAS Total Knee Replacement: A specialised holistic approach that accelerates your recovery

In the realm of orthopaedic surgery, the quest to help patients heal as quickly as possible led to the innovation of Enhanced Recovery After Surgery (ERAS) protocols. With an emphasis on reducing pain, shortening hospitalisation stays and enabling patients to swiftly return to the activities that they love, ERAS strives to improve the patient journey for people contemplating a total knee replacement. ERAS total knee replacement has gained traction in recent years and arguably outperforms conventional knee replacement.

In this article, Dr Jerry Chen, an experienced Consultant Orthopaedic Surgeon from Alps Orthopaedic Centre (a member of Beyond Medical Group) specialising in Enhanced Recovery hip and knee surgeries, will elaborate on the benefits of ERAS for patients who have had knee replacement surgery and whether it is right for you.

When to consider Knee Replacement Surgery

Knee replacement surgery is a common procedure for patients with knee problems which are not adequately addressed by non-invasive treatments. It involves carefully removing the damaged ends of the shin bone and thigh bone and then inserting replacement parts made of metal alloys and polyethylene over the bones to create the new joint.

The decision to go through knee replacement surgery requires careful consideration of various factors. While patients with end-stage osteoarthritis as well as significant wear and degeneration of the knee joints tend to benefit from a knee replacement, those with ligament injuries are usually more suited for knee preservation (i.e. restoring stability and function by repairing or reconstructing damaged ligaments).

Other factors to consider include:

  • Degree of pain and disability: severe pain, difficulty in walking or performing daily activities may indicate the need for knee replacement surgery.
  • Fitness for surgery: conditions like heart disease or obesity can impact surgery outcomes and recovery.
  • Risks and potential complications: although knee replacement surgeries are typically safe, there are still small potential risks, such as infection, bone fracture and deep vein thrombosis.

Conventional Knee Replacement Surgery vs ERAS Knee Replacement Surgery

The fundamental principles of knee replacement surgery remain generally consistent, but there are variations in techniques across different medical facilities in Singapore. One elephant in the room is whether ERAS has been employed to help patients attain faster recovery. Although ERAS’s specialised approach is promising, few orthopaedic surgeons in Singapore have successfully mastered its invaluable knee surgery protocols.

Potential benefits of opting for ERAS knee replacement surgery rather than traditional knee replacement surgery

Faster recovery Instead of the average hospital stay of four days, you will probably experience a shortened hospitalisation. The ERAS programme speeds up your recovery so that you can get back on your feet earlier.
Safer As reported by the Singapore General Hospital, a systematic review and meta-analysis of ERAS analysing 25 studies has concluded that ERAS significantly lowers the mortality rate, blood transfusion rate, and incidence of perioperative complications. (Deng et al. 2018).
Reduced postoperative pain The ERAS option is less invasive than traditional surgery. There will be less tissue disturbance. As a result, you are likely to have a smaller scar and a more comfortable recovery.
Smaller bill The shortened hospital stay makes knee replacement surgery more affordable.

ERAS (Enhanced Recovery) Total Knee Replacement Surgery

The ERAS approach is an evidence-based and multidisciplinary perioperative care pathway that aims to facilitate rapid recovery for patients, which is in part achieved by capitalising on sophisticated technological advancements. The approach involves three main parts: before, during and after surgery.

Before surgery

The process begins with getting the patient in great shape before the operation. To aid in this process, orthopaedic surgeons typically provide tailored lifestyle recommendations and certain treatments beforehand.

  • Stop smoking and alcohol use four weeks ahead of surgery
  • Get nutritional advice and checkups; eat foods rich in carbohydrates.
  • Stick to water intake until two hours before surgery, with a six-hour fast for solid food.
  • Check and treat anaemia, if present.

During the surgery

The kinematic-alignment (KA) technique in total knee replacement (TKR) leverages technological advancements to enhance surgical outcomes:

Technologically-assisted customisation: kinematic alignment aims to mimic a patient’s natural knee geometry by accurately aligning the prosthetic with the pre-arthritic and native joint lines. This alignment is more personalised compared to traditional mechanical alignment and can be facilitated by sophisticated imaging and computer-aided surgery to ensure that the implant functions more naturally for each patient.

Robotic-assisted surgery: the use of robotic systems like the Stryker MAKO and Zimmer ROSA allows for more accurate bone cuts and soft tissue balancing according to the kinematic axes. This results in more accurate alignment, reduced trauma to the surrounding tissues and more consistent outcomes.

More importantly, good surgical technique that minimises soft tissue dissections during surgery, coupled with the use of periarticular injection and nerve block during TKR, has significantly eased postoperative pain.

After the surgery

Admittedly, at first glance, it seems better for all patients to stay overnight after a knee replacement. But that is not necessarily the case for everyone. Depending on individual cases, carefully selected patients under the ERAS programme can benefit from an 18-hour discharge after surgery. An earlier discharge generally reduces the risk of hospital-acquired infections and promotes quicker recovery in a more comfortable, home setting. These benefits are made possible mainly because of recent ERAS developments in surgical and anaesthesia techniques.

ERAS has allowed over 2,000 suitable patients to safely leave the hospital sooner without compromising their post-operative care quality. A study has found that patients who received ERAS day surgery for TKR experienced similar enhancements in functional ability and quality of life to those undergoing ERAS inpatient TKR, without a heightened risk of complications.

By implementing ERAS protocols, orthopaedic surgeons and healthcare teams can shorten hospital stays, minimise complications and enhance overall recovery outcomes for knee replacement surgery.

Consult an Orthopaedic Surgeon

If you are seeking tailored advice on whether ERAS total knee replacement is suitable for your unique condition, you can book an appointment with Dr Jerry Chen, an experienced Consultant Orthopaedic Surgeon from Alps Orthopaedic Centre (a member of Beyond Medical Group). Alps is a specialist clinic which is conveniently located at Singapore’s Mount Elizabeth Hospital (Orchard).


Q: Is Total Knee Replacement right for me?

Whether you require a total knee replacement will depend on your orthopaedic surgeon’s diagnosis. A partial knee replacement might be more appropriate if you’re experiencing pain on just one side of the knee.

Q: What is recovery like after an ERAS Total Knee Replacement?

At the Alps Orthopaedic Centre, eligible patients can choose day surgery as part of our Enhanced Recovery After Surgery (ERAS) programme. Our goal is to reduce the recovery time so patients can quickly return to their favourite activities.

Following ERAS Total Knee Replacement surgery, orthopaedic surgeons will suggest physiotherapy and wound care treatments to help patients restore strength, flexibility, and stability in their knee, facilitating a fast return to everyday activities. Sometimes, the use of a walking aid may be recommended during recovery. Participation in a professionally supervised rehabilitation programme is also advised.

Typically, patients are able to walk with assistance on the evening of the surgery itself. It’s important to remember, however, that recovery times can vary greatly among individuals, depending on age, overall health, and the degree of joint damage experienced.


Contributed by Dr Jerry Chen, Consultant Orthopaedic Surgeon from Alps Orthopaedic Centre (a member of Beyond Medical Group).

Images: Shutterstock and Alps Orthopaedic Centre (for Dr Jerry Chen)

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