Behind the ERAS® Approach for Knee Replacement Surgery

For many people, persistent knee pain can make even simple activities challenging. Thankfully, advances in surgical care — including the Early Recovery After Surgery (ERAS®) approach — have transformed the way patients experience knee replacement. Dr Kelvin Tan, Orthopaedic Surgeon at Gleneagles Hospital, shares how this approach focuses on preparation, comfort, and coordinated recovery to help patients return to an active lifestyle sooner.

Why someone might need knee replacement surgery

If knee pain is keeping you from doing what you love — whether that’s taking long walks, enjoying time with family, or simply climbing the stairs — you’re not alone. This pain often results from age-related wear and tear, injury, or conditions such as osteoarthritis.

When non-surgical options such as physiotherapy, medications, or injections no longer provide enough relief, your orthopaedic surgeon may recommend a knee replacement. While it’s most common in older adults, younger patients with significant joint damage may also benefit from the procedure.

What happens during knee replacement surgery

Knee replacement surgery, or knee arthroplasty, involves removing the damaged portions of the knee joint and replacing them with artificial components made from metal and medical-grade plastic.

Some surgeons may use robot-assisted technology to enhance precision and alignment, allowing the procedure to be customised to each patient’s anatomy.

Understanding the ERAS® approach

The Early Recovery After Surgery (ERAS®) approach is a structured, evidence-based care pathway that supports patients through every stage of surgery and recovery. It focuses on optimising preparation, improving pain control, promoting early movement, and ensuring coordinated care across the healthcare team.

Unlike traditional methods that focus mainly on the operation itself, the ERAS® approach looks at the entire journey — from pre-surgery preparation to post-surgery rehabilitation.

For knee replacement surgery, the ERAS® approach typically includes:

• Pre-surgery preparation: Guidance on exercise, nutrition, and lifestyle adjustments to improve readiness for surgery.
• Optimised pain management: Use of techniques that reduce discomfort and minimise reliance on strong painkillers.
• Early mobilisation: Encouraging safe movement soon after surgery to support circulation and healing.
• Fluid and nutrition balance: Ensuring adequate hydration and nutrition to promote faster recovery.
• Team-based care: Collaboration among surgeons, anaesthetists, nurses, physiotherapists, and dietitians for seamless support.

Together, these elements help patients regain mobility and independence more efficiently and comfortably.

Before surgery: Preparing your body and mind

Preparation plays a big role in successful recovery. Under the ERAS® approach, patients are guided to:

• Optimise health: Stop smoking or drinking alcohol several weeks before surgery, and treat conditions such as anaemia where possible.
• Stay active: Physiotherapy and light exercise can help strengthen muscles around the knee, improving recovery after surgery.
• Be informed: Pre-operative education helps patients understand what to expect and reduces anxiety about the procedure.
• Prepare mentally: Some hospitals offer counselling or relaxation strategies to help patients feel more confident before surgery.

During surgery: Comfort and precision

The ERAS® approach encourages minimally invasive surgical techniques where suitable, using smaller incisions to reduce tissue trauma and promote faster recovery.

Patients receive modern anaesthesia methods combined with multimodal, non-opioid pain management. This often includes local infiltration injections around the knee and/or regional nerve blocks. These techniques work together to reduce pain and discomfort while avoiding common anaesthesia side effects such as nausea, vomiting, giddiness, and excessive blood loss. They also enable patients to start moving earlier and more comfortably after surgery.

Throughout the operation, a multidisciplinary team — including surgeons, anaesthetists, and nurses — works closely to ensure safety, minimise blood loss, and support the best possible outcomes.

After surgery: Getting back on your feet

Recovery begins almost immediately after surgery.

• Early mobilisation: Patients are encouraged to start moving — often within hours of surgery — with guidance from physiotherapists. Early movement improves circulation, reduces stiffness, and lowers the risk of complications like blood clots.
• Effective pain management: Immediately after surgery, advanced pain relief methods such as nerve blocks and non-opioid medications are used, to minimise pain, discomfort and avoiding side effects of anesthesia such as nausea, vomiting, giddiness and blood loss and allows for earlier mobility.
• Coordinated care: Surgeons, nurses, physiotherapists, and dietitians continue to work together to support recovery through exercise, nutrition, and careful monitoring.
• Smooth discharge: Many patients can return home within a few days, once they can move safely and manage pain comfortably. Follow-up physiotherapy and check-ups ensure ongoing progress.

Life after knee replacement

Post-surgery recovery continues at home with guided physiotherapy, a balanced diet, and regular follow-up visits. Over time, most patients experience less pain, better mobility, and a significant improvement in their quality of life.

Taking the next step

Knee replacement surgery is a significant decision that should be made with careful consideration and guidance. With proper preparation, expert care, and a structured recovery plan such as the ERAS® approach, patients can be supported through a smoother recovery process.

If knee pain or stiffness is affecting your daily life, speak with an orthopaedic surgeon. They can assess your condition and guide you on whether surgery — or another form of treatment — may be right for you.