History and future challenges in fast-track hip and knee arthroplasty

Excerpt

The first detailed description of the fast-track or enhanced recovery surgical program (ERP) was in 1997 [11] and based on preliminary observations from relatively minor abdominal procedures, laparoscopic colonic resection and even hip and knee arthroplasty (THA/TKA) [11, 16, 22]. Although the concept of clinical pathways has been evaluated especially in the USA in orthopedic surgery in the 1990s they were more focused on organizational issues and not going into the pathophysiological mechanisms of postoperative recovery and strategies for improvement. The ERP concept has from the very beginning been based on the questions “Can the operation be done as an outpatient procedure?” and then if not “Why is the patient in hospital?” and subsequently focusing on the individual factors delaying early recovery. …