Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2021; 12(6): 346-359
Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.346
Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery
Maria Bourazani, Eleni Asimakopoulou, Chrysseida Magklari, Nikolaos Fyrfiris, Ioannis Tsirikas, Giakoumis Diakoumis, Martha Kelesi, Georgia Fasoi, Theodoros Kormas, Gunhild Lefaki
Maria Bourazani, Eleni Asimakopoulou, Chrysseida Magklari, Nikolaos Fyrfiris, Gunhild Lefaki, Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
Maria Bourazani, Martha Kelesi, Georgia Fasoi, Department of Nursing, University of West Attica, Athens 12243, Attica, Greece
Ioannis Tsirikas, Physiotherapy Center, Egaleo, Athens 12242, Attica, Greece
Giakoumis Diakoumis, Theodoros Kormas, Orthopedic Clinic, “Saint-Savvas” Anticancer Hospital of Athens, Athens 11522, Attica, Greece
Author contributions: Bourazani M wrote the main article; Asimakopoulou E wrote the “Anesthetic protocol” and “Intraoperative analgesia”; Magklari C and Fyrfiris N wrote the “Neuraxial and Regional analgesia/anesthesia”; Diakoumis G wrote the orthopedic introduction and the surgical management; Tsirikas I wrote the physiotherapy rehabilitation; Kormas T and Lefaki G were the coordinators of the literature review; Kelesi M and Fasoi G were honored as supervisors.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Maria Bourazani, MSc, PhD, RN, Academic Research, Nurse, Department of Anesthesiology, “Saint-Savvas” Anticancer Hospital of Athens, 117 Alexandras Avenue, Athens 11522, Attica, Greece.
Received: November 30, 2020
Peer-review started: November 30, 2020
First decision: April 6, 2021
Revised: April 20, 2021
Accepted: May 7, 2021
Article in press: May 7, 2021
Published online: June 18, 2021

Enhanced recovery after surgery (ERAS) protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team. ERAS pathways include pre-operative patient counselling, regional anesthesia and analgesia techniques, post-operative pain management, early mobilization and early feeding. Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty, compared with those who followed a traditional care approach. ERAS protocols reduce post-operative stress, contribute to rapid recovery, shorten length of stay (LOS) without increasing the complications or readmissions, improve patient satisfaction and decrease the hospital costs. We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement. These programs require good organization and handling by the multidisciplinary team. ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment. The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis, with a view to improving the surgical outcomes.

Keywords: Hip or knee replacement, Joint reconstruction, Enhanced recovery after orthopedic surgery, Fast-track orthopedic surgery, Enhanced recovery after surgery pathways in orthopedic surgery, Rehabilitation after hip or knee replacement

Core Tip: Enhanced recovery after surgery (ERAS) pathways are applied to oncology patients undergoing primary total hip replacement or total knee replacement; and through evidenced practices are used by the multidisciplinary team, with the aim of reducing the perioperative stress and its effects. ERAS protocols have been reported to promote early recovery, early mobilization, early feeding, and better pain management with multimodal analgesia. ERAS pathways in orthopedic surgery, also, reduce postoperative length of stay, postoperative complications and mortality by 30 d after surgery, hospital costs, and readmission rate by 30 d after discharge.