Effect of a multi-component enhanced recovery after surgery integrated protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery after knee and hip arthroplasty: a retrospective cohort study

ObjectiveTo investigate the impact of a multicomponent enhanced recovery after surgery (ERAS) protocol based on preoperative risk stratification and dynamic rehabilitation adjustment on functional recovery following total knee arthroplasty (TKA) or total hip arthroplasty (THA).MethodsA retrospective cohort study was conducted, enrolling 256 patients who underwent primary unilateral TKA or THA at the Ninth Medical Center of the Joint Logistics Support Force of the People's Liberation Army between September 2023 and September 2024. Patients were divided into a study group (n = 128) receiving an ERAS protocol guided by rehabilitation assessment and a control group (n = 128) receiving a conventional ERAS protocol. The study group underwent preoperative risk stratification using a predictive model (low, medium, high) and received individualized, stepwise rehabilitation training based on daily activity load monitored via wearable devices; the control group followed a standardized, uniform rehabilitation protocol. Primary outcome measures included Visual Analog Scale (VAS) scores preoperatively and postoperatively at 1 day, 3 days, 1 month, 3 months, and 6 months. HSS scores were used for TKA patients and Harris scores for THA patients. Generalized estimating equations were applied to adjust for baseline confounding factors. Incidences of deep vein thrombosis (DVT) and surgical site infection (SSI) were also recorded.ResultsAfter adjusting for baseline confounders, the intervention group had significantly lower VAS pain scores across all postoperative follow-up time points (P < 0.05). For TKA patients, the intervention group showed significantly higher HSS scores than the control group starting from postoperative day 3 (P < 0.05): the control group had no significant change in HSS score on postoperative day 3 vs. baseline (P > 0.05), while the intervention group achieved significant improvement at the same time point (P < 0.05). For THA patients, the intervention group had significantly higher Harris hip function scores than the control groups starting from postoperative day 3 (P < 0.05): the control group showed no significant difference in Harris score on postoperative day 3 vs. baseline (P = 0.069), with significant improvements observed at 1, 3, and 6 months postoperatively (P < 0.05). No significant intergroup differences were found in the incidences of DVT and SSI in either the TKA or the THA subgroups (P > 0.05).ConclusionThe multicomponent ERAS protocol incorporating preoperative risk stratification and dynamic rehabilitation adjustment is significantly associated with improved short-term pain relief and functional recovery after TKA and THA. A prominent functional improvement trend was observed, especially during the critical early rehabilitation window at 1-month post-arthroplasty. The intergroup differences in both HSS and Harris Hip scores peaked at 3 months postoperatively. These findings provide real-world observational evidence supporting precision rehabilitation following joint arthroplasty.