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Optimizing and accelerating postoperative recovery for TKA patients is critical in clinical practice. Enhanced Recovery After Surgery (ERAS) is a protocol involving a series of evidence-based perioperative optimization strategies to minimize surgical stress and expedite recovery, and a multidisciplinary ERAS pathway was established jointly by anesthesiologists and orthopedic surgeons in this study. The authors hypothesized that application of the ERAS pathway can reduce the length of hospital stay (LOS) for patients undergoing primary TKA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and Methods<\/jats:title>\n            <jats:p>This multicenter, prospective, randomized controlled trial was conducted from February 1, 2021 to January 31, 2023, and included patients undergoing elective primary TKA. 320 patients were randomly assigned to either the ERAS group (practice according to the ERAS pathway) or the control group (without ERAS pathway implementation) in a 1:1 ratio. The primary outcome was the total LOS in hospital.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>LOS in the ERAS group was 5.92\u2009\u00b1\u20091.16\u00a0days, significantly shorter than the 8.17\u2009\u00b1\u20091.76\u00a0days in the control group (p\u2009&lt;\u20090.001). Postoperative LOS and time to independent ambulation were significantly shorter in the ERAS group compared to the control group (p\u2009&lt;\u20090.001). On postoperative day 1, significantly less participants reported pain both in rest and during mobilization in the ERAS group than the control group (p\u2009&lt;\u20090.001). The incidences of thirst and postoperative nausea and vomiting (PONV) was significantly reduced in the ERAS group compared to the control group (16.8% vs. 88.6%, and 2.6% vs. 24.7%, respectively, p\u2009&lt;\u20090.001). No perioperative deaths or reoperations within 30\u00a0days occurred in either group.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The application of an ERAS pathway for primary TKA significantly reduces LOS, alleviates postoperative pain, and lowers the incidence of adverse events compared to perioperative management without ERAS pathway implementation.<\/jats:p>\n            <jats:p>\n              <jats:italic>Trial registration<\/jats:italic>: The National Institutes of Health Clinical Trials Registry, NCT03517098. Registered on April 24, 2018.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40001-025-02647-8","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T16:41:42Z","timestamp":1747240902000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Reducing the length of hospital stay for patients undergoing primary total knee arthroplasty by application of enhanced recovery after surgery (ERAS) pathway: a multicenter, prospective, randomized controlled trial"],"prefix":"10.1186","volume":"30","clinical-trial-number":[{"clinical-trial-number":"nct03517098","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1865-1932","authenticated-orcid":false,"given":"Chenxi","family":"Liao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9096-7474","authenticated-orcid":false,"given":"Xingning","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3735-0282","authenticated-orcid":false,"given":"Jie","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2536-9407","authenticated-orcid":false,"given":"Wencong","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiannan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanxin","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayun","family":"Shu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0070-1934","authenticated-orcid":false,"given":"Haobo","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangyu","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3963-4310","authenticated-orcid":false,"given":"Ren","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"issue":"4","key":"2647_CR1","doi-asserted-by":"publisher","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","volume":"89","author":"S Kurtz","year":"2007","unstructured":"Kurtz S, Ong K, Lau E, Mowat F, Halpern M. 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The participants were explained in detail about the purpose of the study, assurance of their confidentiality and privacy of their information, and their voluntary nature of participation. Written informed consent was provided by each participant, and they were fully aware that they can stop cooperation or withdraw at any given time without any reason. A copy of the written informed consent is available for review upon request to the corresponding author or the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"(1) Name of the registry: The National Institutes of Health Clinical Trials Registry. (2) Unique identifying number or registration ID: NCT03517098. (3) Hyperlink to the registration (must be publicly accessible and will be checked):","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research registration unique identifying number (UIN)"}},{"value":"The corresponding author, Dr. Ren Liao, is the guarantor of this study and accept full responsibility for the work and\/or the conduct of the study, had access to the data, and controlled the decision to publish.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}}],"article-number":"385"}}