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An enhanced recovery after surgery program for hip and knee arthroplasty

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Osteoarthritis is the leading cause of pain and disability among the elderly and affects 15% of the population. Despite a range of treatments for osteoarthritis (OA), joint replacement remains the main treatment option for patients in whom the disease has progressed.1

In Victoria, more than 20 000 hip and knee joint replacements are now performed each year, reflecting orthopaedic practices globally. The prevalence of OA and the need for joint replacement are likely to increase because of a combination of increasing risk factors (age, obesity) and improved surgical and anaesthetic techniques that make surgery possible for more people.1

Across health services, there is wide variation in hospital length of stay for patients receiving hip and knee replacements. This is probably independent of casemix and more reflective of varying health service practices. Surgical injury, pain, stress-induced catabolism, impaired organ function and impaired cognitive function may contribute to complications, prolonged hospitalisation, postoperative fatigue, delayed convalescence and the need for rehabilitation. Optimisation of individual care components in perioperative care (the fast-track methodology) reduces the need for prolonged hospitalisation and convalescence, and reduces morbidity, with subsequent economic savings.2