5E management protocol for enhanced recovery after total knee arthroplasty: stratified RCT

Area of Science:

• Orthopedic Surgery
• Pain Management
• Rehabilitation Medicine

Background:

• Total knee arthroplasty (TKA) recovery is often limited by pain and delayed rehabilitation.
• Conventional care underemphasizes patient education, nutrition, and psychological well-being.
• The 5E protocol integrates Education, Exercise, Eat, Emotion, and Ease for comprehensive perioperative management.

Purpose of the Study:

• To evaluate the efficacy of the 5E protocol in improving early postoperative pain control and functional recovery after TKA.
• To assess the consistency of the 5E protocol's effects across various patient subgroups.

Main Methods:

• A single-center randomized controlled trial involving 120 patients undergoing primary TKA.
• Patients were assigned to either the 5E protocol (n=60) or conventional care (n=60).
• Pain (VAS, NRS) and functional outcomes (KSS, WOMAC) were assessed at multiple time points; subgroup analyses included BMI, diabetes, and K-L grade.

Main Results:

• The 5E protocol group showed significantly better early pain control (VAS day 1: 1.95 vs. 3.08) and superior 30-day functional outcomes (higher KSS, lower WOMAC).
• Benefits were consistent across BMI, diabetic status, and K-L grade subgroups.
• No significant long-term differences were observed, and thrombotic complication rates were similar between groups (16.7% vs. 13.3%).

Conclusions:

• The 5E protocol significantly enhances early postoperative pain control and short-term functional recovery following TKA.
• This structured, patient-centered approach offers clinical value by accelerating recovery.
• The 5E protocol demonstrates a comparable safety profile to conventional care regarding thrombotic complications.