The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Clinical Outcomes and Complication Rates in Fast-Track Versus Routine after Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Document Type : SYSTEMATIC REVIEW

Authors
Abdul Qadim Esehaqzai 1
Mohammad H. Ebrahimzadeh 1
Masoumeh Sadeghi 2
Amir Moayedpour 1
Mohammad Zarei Dezkooh 1
Shahram Rahimi 1
Mahdieh Samei 1
1 Orthopedics Research Center, Ghaem Hospital, Mashhad University of medical Sciences, Mashhad, Iran
2 Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/abjs.2026.95214.4278
Abstract
Objectives: Fast-track or enhanced recovery after surgery (ERAS) pathways have been increasingly adopted in total knee arthroplasty (TKA) to optimize perioperative care, yet their comparative effectiveness and safety relative to routine pathways remain incompletely defined. This systematic review and meta-analysis compared the effects of fast-track versus routine perioperative care on length of hospital stay (LOS), postoperative pain, complications, and readmissions in patients undergoing primary TKA.
Methods: A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was performed from inception to January 2025 using MeSH terms. Primary outcomes were LOS and postoperative pain, with complications and readmissions assessed as secondary outcomes. Risk of bias was assessed using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. A random-effects meta-analysis was conducted due to anticipated heterogeneity.
Results: Nine studies (total 2607 patients) met inclusion criteria. Fast-track care significantly reduced LOS (WMD: -2.41 days, 95% CI: -3.18 to -1.64). Postoperative pain was slightly higher in the fast-track group at 24h (MD: 0.98, 95% CI: -0.1 to 2.05) and at 2 weeks (MD: 0.33, 95% CI: -0.04 to 0.7), neither reaching statistical significance. Methodological quality was limited, with moderate to serious risk of bias in non-randomized studies and high risk of bias in all randomized trials.
Conclusion: Overall, the available evidence suggests that fast-track rehabilitation following TKA substantially reduces hospitalization without clinically meaningful or sustained increases in postoperative pain. These findings support the use of fast-track pathways to enhance perioperative efficiency in TKA, while highlighting the need for higher-quality randomized studies to better define their effects on pain and safety outcomes.
        Level of evidence: III
Keywords
Fast-track
Rehabilitation
Routine
TKA
Total knee arthroplasty
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 6
June 2026
Pages 371-379

  • Receive Date 22 April 2026
  • Revise Date 21 May 2026
  • Accept Date 25 May 2026