Mid-term clinical outcomes and isokinetic performance after primary total knee arthroplasty within a modified ERAS protocol: a single-blinded randomized controlled trial.
Julia Schiegl, Felix Greimel, Florian Zeman et al.
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In 30 seconds
This prospective, single-blinded randomized controlled trial compared a modified Enhanced Recovery After Surgery (ERAS) protocol with conventional perioperative care in 58 patients undergoing primary total knee arthroplasty. Isokinetic muscle strength, knee flexion, pain, and patient-reported and functional outcomes were assessed through 12 months. At 5 days after surgery, the ERAS group had significantly greater muscle strength and active knee flexion (p < 0.05). These early differences diminished, with no significant between-group differences in strength at 3, 6, or 12 months; one-year PROMs, KOOS scores, and satisfaction were also comparable.
Key findings
- At 5 days postoperatively, the ERAS group had significantly higher isokinetic muscle strength and better active knee flexion than conventional care (p < 0.05).
- No significant between-group differences in muscle strength were observed at 3, 6, or 12 months.
- At one year, patient satisfaction, PROMs, and KOOS scores were comparable between groups.
Why it matters
Muscle weakness can contribute to functional limitations after knee replacement. These findings suggest that a modified ERAS pathway may improve objective strength and knee flexion during the immediate postoperative period, while longer-term measures converge with conventional care. The results help distinguish a potential early recovery benefit from evidence of sustained mid-term superiority.
What to keep in mind
The trial included 58 patients, and the reported between-group strength and flexion benefits were limited to the early postoperative assessment.