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Clinical Outcomes and Complication Rates in Fast-Track Versus Routine after Total Knee Arthroplasty: A Systematic
Abdul Qadim Esehaqzai1, Mohammad H Ebrahimzadeh1, Masoumeh Sadeghi2
11 Orthopedics Research Center, Ghaem Hospital, Mashhad University of medical Sciences, Mashhad, Iran.
The Archives of Bone and Joint Surgery
|August 1, 2026
Summary
Fast-track pathways significantly reduce hospital stays for total knee arthroplasty (TKA) patients. While pain may slightly increase initially, it is not statistically significant, supporting enhanced recovery after surgery (ERAS) protocols.
Area of Science:
- Orthopedic Surgery
- Perioperative Care
- Evidence-Based Medicine
Background:
- Enhanced recovery after surgery (ERAS) pathways, or fast-track protocols, are increasingly used in total knee arthroplasty (TKA).
- The comparative effectiveness and safety of fast-track versus routine perioperative care in TKA require further definition.
Purpose of the Study:
- To systematically review and meta-analyze the effects of fast-track versus routine perioperative care.
- To compare outcomes including length of hospital stay (LOS), postoperative pain, complications, and readmissions in primary TKA patients.
Main Methods:
- Systematic search of major databases (PubMed, Embase, Cochrane Library, Scopus, Web of Science) up to January 2025.
- Included nine studies with 2607 patients; primary outcomes were LOS and pain; secondary outcomes were complications and readmissions.
- Risk of bias assessed using Cochrane RoB 2 and ROBINS-I; random-effects meta-analysis performed.
Main Results:
- Fast-track care significantly reduced LOS by an average of 2.41 days.
- Postoperative pain showed non-significant increases at 24 hours and 2 weeks in the fast-track group.
- Methodological quality was limited, with moderate to serious risk of bias in non-randomized studies and high risk in randomized trials.
Conclusions:
- Fast-track rehabilitation in TKA substantially reduces hospitalization without clinically significant increases in pain.
- Findings support fast-track pathways for perioperative efficiency in TKA.
- Higher-quality randomized studies are needed to clarify effects on pain and safety.