Hip and knee surgery



ENHANCED RECOVERY AFTER SURGERY (ERAS)

The ERAS method consists in a specific care pathway after a surgery. The knee and hip surgeries are well adapted to this type of care pathways. This method enables the patient to significantly reduce the length of stay within the hospital as well as the recovery timeframe after a prosthesis surgery.

The ERAS method was first implemented in Denmark by Henrik Kehlet, MD, in 2007. Then, this innovative method was deployed in Great Britain in 2011.

The essence of ERAS method is based on the patient engagement in order to make him pro-active for his recovery. The more engaged the patient is, the faster and smoother his recovery is. In addition to this patient engagement, the ERAS method requires also the implication of the whole medical team: surgeon, anesthesiologist, nurses, physiotherapists, doctors… In France, the ERAS method was only deployed in April 2014 since ERAS has required a major change in the reimbursement method from the French healthcare system.

Practically, the surgery by itself is just a part of your functional recovery plan after your prosthesis placement. In fact, the arthrosis of your hip or your knee is not a disease. Hence, you don’t have to stay in the hospital more than necessary e.g. few hours to a few days would be enough.

Actually, the downside of a hospital stay is well documented and well known: hospital stays create bad side effects psyche wise and physical wise. Facts show that patients getting an ERAS care pathways have a benefit of a 50% reduction in post-surgery complications. For example, the number of cases of phlebitis has been significantly reduced thanks to the ERAS method.

The ERAS goal can be reached thanks to a new way of pain removal right after your surgery. This advanced pain treatment enables the patient to avoid bad side effects of morphine drugs that are necessary without ERAS (nausea, vomiting, bad mood, urine retention, muscle weakened, …). Secondly, it enables to reduce the length of your hospital stay. Bear in mind that:
  • You are not sick, you just got a surgery
  • You will be able to walk by your own the same day and you are likely to be able to return home by yourself at the end of the afternoon.
  • Everything will be set before your hospital arrival so that your hospital stay will be very smooth


Here are some examples of patients who got a surgery in the morning and walked by the afternoon :


You could also have a look to these slides that I presented during a medical conference in april 2015 about the ERAS method by clicking here : RRAC

In addition, I would like to mention the activity of the French association GRACE (equivalent to the ERAS association). This group of surgeons is very active and promotes the ERAS method all over French speaking countries. On April 29, 2016, was held in Paris the second symposium of GRACE (Groupe francophone de Réhabilitation Accélérée après ChirurgiE).
You could click on the logo to see an example of a GRACE conference program. .
I had the privilege to present a scientific paper during a GRACE conference about: "ERAS protocols for TKA and THA : the feedback of the regular doctor of patients”. You could view this slideshow by clicking You could view this slideshow by clicking here.

You could also get more information through some press clips: here or here or also here or more recently here.

My own experience at the Clinique de l'étang de l'Olivier, Istres :