Effect of a multi-component enhanced recovery after surgery integrated protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery after knee and hip arthroplasty: a retrospective cohort study.
- 1Rehabilitation Medicine Department, Joint Logistics Support Force, People's Liberation Army, No. 940 Hospital, Lanzhou, China.
- 2Department of Orthopedics, Joint Logistics Support Force, People's Liberation Army, No. 989 Hospital, Luoyang, China.
Abstract
Objective
To investigate the impact of a multicomponent enhanced recovery after surgery (ERAS) protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery following total knee arthroplasty (TKA) or total hip arthroplasty (THA).Methods
A retrospective cohort study was conducted, enrolling 256 patients who underwent primary unilateral TKA or THA at the Ninth Medical Center of the Joint Logistics Support Force of the People's Liberation Army between September 2023 and September 2024. Patients were divided into a study group (n = 128) receiving an ERAS protocol guided by rehabilitation assessment and a control group (n = 128) receiving a conventional ERAS protocol. The study group underwent preoperative risk stratification using a predictive model (low, medium, high) and received individualized, stepwise rehabilitation training based on daily activity load monitored via wearable devices; the control group followed a standardized, uniform rehabilitation protocol. Primary outcome measures included Visual Analog Scale (VAS) scores preoperatively and postoperatively at 1 day, 3 days, 1 month, 3 months, and 6 months. HSS scores were used for TKA patients and Harris scores for THA patients. Generalized estimating equations were applied to adjust for baseline confounding factors. Incidences of deep vein thrombosis (DVT) and surgical site infection (SSI) were also recorded.Results
After adjusting for baseline confounders, the intervention group had significantly lower VAS pain scores across all postoperative follow-up time points (P < 0.05). For TKA patients, the intervention group showed significantly higher HSS scores than the control group starting from postoperative day 3 (P < 0.05): the control group had no significant change in HSS score on postoperative day 3 vs. baseline (P > 0.05), while the intervention group achieved significant improvement at the same time point (P < 0.05). For THA patients, the intervention group had significantly higher Harris hip function scores than the control groups starting from postoperative day 3 (P < 0.05): the control group showed no significant difference in Harris score on postoperative day 3 vs. baseline (P = 0.069), with significant improvements observed at 1, 3, and 6 months postoperatively (P < 0.05). No significant intergroup differences were found in the incidences of DVT and SSI in either the TKA or the THA subgroups (P > 0.05).Conclusion
The multicomponent ERAS protocol incorporating preoperative risk stratification and dynamic rehabilitation adjustment is significantly associated with improved short-term pain relief and functional recovery after TKA and THA. A prominent functional improvement trend was observed, especially during the critical early rehabilitation window at 1-month post-arthroplasty. The intergroup differences in both HSS and Harris Hip scores peaked at 3 months postoperatively. These findings provide real-world observational evidence supporting precision rehabilitation following joint arthroplasty.
Related
- Core needle biopsy washout biomarkers combined with ultrasound for preoperative axillary risk stratification in breast cancer: a retrospective nomogram study with temporal validation
- Impact of intertrochanteric bone mineral density on the accuracy of preoperative templating in cementless total hip arthroplasty: a retrospective cohort study of 510 hips.
- Preoperative Staphylococcus aureus nasal screening and decolonization for the prevention of periprosthetic joint infection in elective total joint arthroplasty: A single-center retrospective comparative study.
- Preoperative Malignancy Risk Stratification in Bethesda IV Thyroid Nodules Using Integrated Clinical, Ultrasonographic, and Biochemical Parameters in Surgical Oncology Practice.
- Integrating Systemic Inflammation, Nutrition and Skeletal Muscle into a Composite Score (the HALP–Sarcopenia Combined Index) for Preoperative Risk Stratification of Lymph-Node Metastasis and Recurrence in Endometrial Carcinoma: A Single-Centre Retrospective Study
BibTeX
@article{ma2026effect,
title = {{Effect of a multi-component enhanced recovery after surgery integrated protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery after knee and hip arthroplasty: a retrospective cohort study.}},
author = {Xiaolong Ma and Kai Zhang and Wenbin Yang and Zirui Zhang and Xiuling Li},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1836698},
url = {https://europepmc.org/article/MED/42909070},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effect of a multi-component enhanced recovery after surgery integrated protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery after knee and hip arthroplasty: a retrospective cohort study.
AU - Xiaolong Ma
AU - Kai Zhang
AU - Wenbin Yang
AU - Zirui Zhang
AU - Xiuling Li
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1836698
UR - https://europepmc.org/article/MED/42909070
AB - Objective To investigate the impact of a multicomponent enhanced recovery after surgery (ERAS) protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery following total knee arthroplasty (TKA) or total hip arthroplasty (THA).Methods A retrospective cohort study was conducted, enrolling 256 patients who underwent primary unilateral TKA or THA at the Ninth Medical Center of the Joint Logistics Support Force of the People's Liberation Army between September 2023 and September 2024. Patients were divided into a study group (n = 128) receiving an ERAS protocol guided by rehabilitation assessment and a control group (n = 128) receiving a conventional ERAS protocol. The study group underwent preoperative risk stratification using a predictive model (low, medium, high) and received individualized, stepwise rehabilitation training based on daily activity load monitored via wearable devices; the control group followed a standardized, uniform rehabilitation protocol. Primary outcome measures included Visual Analog Scale (VAS) scores preoperatively and postoperatively at 1 day, 3 days, 1 month, 3 months, and 6 months. HSS scores were used for TKA patients and Harris scores for THA patients. Generalized estimating equations were applied to adjust for baseline confounding factors. Incidences of deep vein thrombosis (DVT) and surgical site infection (SSI) were also recorded.Results After adjusting for baseline confounders, the intervention group had significantly lower VAS pain scores across all postoperative follow-up time points (P < 0.05). For TKA patients, the intervention group showed significantly higher HSS scores than the control group starting from postoperative day 3 (P < 0.05): the control group had no significant change in HSS score on postoperative day 3 vs. baseline (P > 0.05), while the intervention group achieved significant improvement at the same time point (P < 0.05). For THA patients, the intervention group had significantly higher Harris hip function scores than the control groups starting from postoperative day 3 (P < 0.05): the control group showed no significant difference in Harris score on postoperative day 3 vs. baseline (P = 0.069), with significant improvements observed at 1, 3, and 6 months postoperatively (P < 0.05). No significant intergroup differences were found in the incidences of DVT and SSI in either the TKA or the THA subgroups (P > 0.05).Conclusion The multicomponent ERAS protocol incorporating preoperative risk stratification and dynamic rehabilitation adjustment is significantly associated with improved short-term pain relief and functional recovery after TKA and THA. A prominent functional improvement trend was observed, especially during the critical early rehabilitation window at 1-month post-arthroplasty. The intergroup differences in both HSS and Harris Hip scores peaked at 3 months postoperatively. These findings provide real-world observational evidence supporting precision rehabilitation following joint arthroplasty.
SN - 2296-858X
ER -