Enhanced recovery after surgery
The old picture of joint replacement was a week in hospital and a long, passive recovery. Enhanced recovery after surgery, or ERAS, replaced it. The idea is simple: prepare you well, control pain with a combination of methods rather than relying on strong opioids, and get you moving on the day of surgery. Done across every stage, it means less pain, fewer complications, and getting home sooner.
Reviewed by Dr Jason Tsung · 5 min read
What ERAS is
ERAS is an evidence-based pathway that runs from before surgery to after you go home. It isn't one technique. It's a set of coordinated steps, each backed by research, that together change how recovery goes. Dr Tsung follows an ERAS pathway for hip and knee replacement.
Before surgery: preparation
Recovery starts before the operation. Going in stronger and better prepared helps you recover faster afterward. This means education about what to expect, so there are fewer surprises, and exercises to build strength in the muscles around the joint. Dr Tsung's patients can use a prehabilitation program for this part, described below.
During surgery: pain control and less blood loss
Modern anaesthesia and pain control use a combination of medications that target pain in different ways, which keeps you comfortable while reducing the need for strong opioids and their side effects. Tranexamic acid, a medication that reduces bleeding, is used to limit blood loss during surgery. Together these set up a smoother start to recovery.
After surgery: moving early
The most important change is the simplest. A physiotherapist helps you get up and moving, often on the day of your operation. Early movement reduces stiffness, lowers the risk of blood clots, and speeds healing. Alongside it: eating and drinking soon after surgery, removing tubes and drains quickly, and a structured plan to manage pain as it eases. Most people go home within one to three days, rather than the five to seven that used to be standard.
What the research shows
Large studies of ERAS in joint replacement report:¹,²
- shorter hospital stays, with many people home within one to three days
- less pain after surgery, and a reduced need for strong opioids
- fewer complications
One large meta-analysis found that, compared with conventional care, an ERAS pathway lowered the rate of complications by about a quarter.¹ These are findings for the pathway as a whole. Your own recovery depends on your health, the operation, and how recovery goes, and individual results vary.
Prehabilitation: preparing before surgery
Prehabilitation builds your strength in the weeks before surgery, so you go into the operation in the best shape possible. Dr Tsung's preferred way to deliver it is a telehealth program,³ run through a smartphone app and supported by a physiotherapist, that you do from home.
He prefers it for one reason: continuity. The same care team guides you before, during and after surgery, instead of handing you to outside providers who don't speak with us directly. The program starts before the operation and stays with you through recovery, and doing it from home means fewer unnecessary trips. It's optional, and our staff can help you enrol.
What it means for you
ERAS is the difference between enduring a recovery and being guided through one. With preparation before surgery, modern pain control during it, and early movement after, the aim is to get you back on your feet quickly and safely. Dr Tsung will explain how the pathway applies to your operation.
Common questions
Will I really be up on the day of surgery?
Usually, yes. Early movement is a core part of ERAS, and a physiotherapist helps you do it safely. It’s one of the most important parts of recovery.
Does ERAS mean less pain medication?
It means a combination of medications that control pain while reducing the need for strong opioids. The aim is good pain control with fewer side effects.
How long will I be in hospital?
Most people go home within one to three days, though this depends on your operation and how your recovery goes.
Speak to Dr Tsung
Dr Tsung performs hip and knee replacement following an enhanced recovery pathway. To discuss your options, you'll need a referral from your GP or another specialist. Call reception on (07) 5676 9930 to book your first appointment, or email hello@sgco.au. New patients can pre-register online before the visit; the form prepares your records and does not book an appointment. More on hip replacement and knee replacement.
References
- Deng QF, Gu HY, Peng WY, et al. Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis. Postgrad Med J. 2018;94(1118):678–693.
- Zhu S, Qian W, Jiang C, Ye C, Chen X. Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J. 2017;93(1106):736–742.
- JointFit Surgical, by Beyond The Clinic (Gold Coast, Australia). https://www.beyondtheclinic.io/jointfit