ERAS — Enhanced Recovery After Surgery

Walking on
day one.

ERAS is a coordinated set of evidence-based practices applied before, during, and after surgery - removing the unnecessary barriers that historically slowed recovery.

~95%

of Dr de Hoog's hip and knee patients home within 24 hours of surgery

What ERAS changes

Traditional joint replacement recovery was built around assumptions that evidence has since overturned. ERAS replaces those assumptions with what actually works.

Traditional approach

  • × Prolonged pre-operative fasting
  • × Routine opioid-heavy analgesia
  • × Urinary catheters as standard
  • × Wound drains routinely used
  • × Extended bed rest after surgery
  • × Slow rehabilitation start
  • × Average 5–7 day hospital stay

ERAS approach

  • ✓ Minimal fasting — carbohydrate loading before surgery
  • ✓ Multimodal analgesia — less opioid, less side effects
  • ✓ Avoid unnecessary tubes and catheters
  • ✓ No routine drains
  • ✓ Standing and walking on the day of surgery
  • ✓ Active rehabilitation from day one
  • ✓ Average 1–2 night hospital stay

The ERAS protocol

ERAS is a coordinated approach across three phases - not a single technique.

Before Surgery

  • Pre-operative education

    What to expect, how to prepare, and what recovery looks like — discussed at your consultation.

  • Medical optimisation

    Any existing health conditions are managed to reduce surgical risk.

  • Carbohydrate loading

    A carbohydrate drink before surgery — not starvation. Evidence shows it helps.

  • Pre-medication

    Anti-nausea and analgesic medications before you enter theatre reduce post-operative symptoms.

During Surgery

  • Regional anaesthetic

    Spinal anaesthesia and nerve blocks reduce systemic drug load and post-operative pain.

  • Local infiltration analgesia

    Local anaesthetic injected around the joint at the time of surgery for immediate post-operative comfort.

  • Careful fluid management

    Fluid balance is actively managed rather than over-loaded.

  • Minimising tubes and drains

    Urinary catheters and wound drains are avoided unless specifically indicated.

After Surgery

  • Walk on the day of surgery

    Patients stand and walk with the physiotherapist the same day as their operation.

  • Multimodal pain management

    Paracetamol, anti-inflammatories, and nerve blocks combine to reduce opioid use.

  • Early oral intake

    Eating and drinking resume as soon as tolerated — not hours later.

  • Discharge planning from day one

    The goal of returning home is set before admission and worked toward actively.

~95%

of hip & knee patients home within 24 hours

1–2 nights

average hospital stay for joint replacement

Day 1

physiotherapy and walking after surgery

What this means for you

Walk on the day of surgery

This is standard, not exceptional. Patients are up with the physiotherapist the same day.

Less reliance on strong opioids

And the nausea, confusion, and constipation that come with them.

Shorter hospital stay

Most total hip and knee replacements are 1–3 nights, not a week.

Faster return to independence

Driving within 2–3 weeks (hip), weight-bearing from day one (knee).

A coordinated team

Nursing, physio, anaesthetics, and surgery working to the same evidence-based plan.

In Dr de Hoog's words

"ERAS doesn't mean rushing recovery or discharging patients before they are ready. It means removing the unnecessary barriers that have historically slowed recovery - so that when patients are ready to progress, nothing is holding them back."

— Dr Jonathon de Hoog, FRACS (Orth)

ERAS is applied to all hip and knee replacement surgery at Aspire Orthopaedics:

Total Hip Replacement → Total Knee Replacement →

Questions about ERAS?

Your recovery is discussed in detail at the consultation. To see Dr de Hoog, a GP referral is the starting point.

Get a referral Email the clinic