Total knee arthroplasty(TKA) is the most commonly performed procedure for advanced knee osteoarthritis. Enhanced recovery after surgery (ERAS) protocols are primarily implemented to reduce perioperative stress and improve surgical and functional outcomes. Evidence of the implementation of ERAS protocols in low to middle-income countries like Pakistan is limited. This study aims to evaluate the effectiveness of ERAS protocols in TKA patients.

A prospective randomized controlled trial study was conducted within our institute from July 2025 to January 2026, in which a total of 239 patients who underwent primary bilateral TKA, of which 121 patients received conventional treatment and protocols, and a study group with 120 participants were managed according to the ERAS protocol. Patients were in the 50-70 years age bracket, and had an American Society of Anesthesiologists grade I-III. The protocol included preoperative physiotherapy, reduced fasting time, multimodal anesthesia, perioperative tranexamic acid, early ambulation and early oral intake. Postoperative outcomes included time to oral intake, postoperative nausea and vomiting, time to mobilization, length of hospital stay, range of motion and Hospital for Special Surgery score.

Inclusion Criteria:

• ASA grade of 1-3 BMI was restricted to less than 30 kg/m²

Exclusion Criteria:

• ASA grade of IV or higher uncontrolled comorbidities not consenting to the protocol