Enhanced Recovery in Hip and Knee Arthroplasty: Findings from a Swiss Quasi-Experimental Orthopaedic Study

Background Enhanced recovery protocols (ERPs) are designed to accelerate postoperative recovery and reduce hospital length of stay (LoS). Among ERP components, early mobilization plays a pivotal role in improving functional outcomes, reducing complications, and enhancing patient satisfaction. However, most evidence originates from large tertiary centers, leaving uncertainty about the feasibility and impact of such interventions in smaller hospitals with more limited resources. This study aimed to evaluate whether implementing a structured early mobilization protocol could reduce LoS and improve functional recovery after total knee (TKA) and total hip arthroplasty (THA) in a Swiss peripherical hospital. Methods A quasi-experimental pre/post study was conducted at a single orthopedic unit as a retrospective analysis of a practice change. Adults undergoing elective unilateral TKA or THA were included. Exclusion criteria were bilateral procedures, major postoperative complications or impairing mobilization. Patients operated before April 2021 received standard postoperative care, while those treated from November 2021 onwards followed the ERP. The ERP emphasized early mobilization and optimized perioperative analgesia, including preoperative education, physiotherapy, minimally invasive techniques, periarticular local infiltration, and replacement of femoral nerve blocks with adductor canal blocks. Physiotherapist-led mobilization began within 4–6 hours postoperatively, with walking and stair climbing on day one. The primary outcome was hospital LoS. Secondary outcomes were time to cane use, unaided ambulation, stair climbing, knee flexion at discharge (for TKA), and reported pain. Statistical analyses included non-parametric tests and chi-square comparisons, as appropriate. Additionally, linear multivariable regression and linear mixed-effects models were applied to examine associations between the intervention and key outcomes, adjusting for potential confounders and repeated measures. Results Patients in the intervention group had a significantly shorter median LoS compared to the control group (4 vs. 5.5 days, P < 0.01). The enhanced protocol was significantly associated (P < 0.01) with earlier achievement of functional milestones, including cane use, stair climbing, and attainment of adequate knee flexion. Improvements among THA patients were more modest. Multivariable modeling identified sex, age, and body mass index as significant predictors of recovery outcomes. No significant reduction in pain was observed. Conclusions ERP implementation was associated with shorter hospitalization and faster functional recovery, particularly after TKA. These findings support integrating structured early mobilization pathways to improve outcomes and efficiency, especially in smaller hospitals where reduced LoS can optimize bed occupancy and resource use.