Enhanced Recovery After Surgery — Melbourne

ERAS+: Enhanced Recovery After Surgery

ERAS is a structured, evidence-based pathway that covers every stage of your operation — from the weeks before surgery through to the day you go home. The goal is simple: less pain, fewer complications, and getting you back on your feet sooner and more safely.

We call our version ERAS+ because we add prehabilitation, objective testing and digital follow-up to the standard pathway.

What Is Enhanced Recovery After Surgery?

Traditional surgical care often meant prolonged fasting, bed rest, strong opioids and a long hospital stay. ERAS replaces that with a coordinated plan in which the surgeon, anaesthetist, physiotherapist and nursing team all follow the same evidence-based steps.

The ERAS Society publishes consensus recommendations for hip and knee replacement, and organises care into four stages: before surgery, during surgery, after surgery, and discharge.

Before Surgery: Preparation and Optimisation

Education. You know what will happen, when, and what is expected of you. Clear expectations reduce anxiety and improve recovery.
Prehabilitation. A structured program to build strength, mobility and cardiovascular fitness before your operation.
Medical optimisation. Reviewing anaemia, diabetes, blood pressure, medications and bone health, in partnership with your GP.
Lifestyle. Smoking cessation, alcohol moderation and weight management, where relevant.
Planning your discharge early. Home setup, equipment and support are arranged before you are admitted, not on the day you leave.

More detail: Prehab: Preparing for Surgery and the Biomechanical Profile Assessment.

During Surgery

Muscle-sparing technique. Less tissue trauma means less pain and faster mobilisation — for example the anterior approach for hip replacement and the quadriceps-sparing subvastus approach for knee replacement.
Standardised anaesthesia. Techniques chosen to let you wake comfortable, alert and able to move.
Multimodal, opioid-sparing pain relief. Several medications working together, including local anaesthetic around the joint, so we rely less on strong opioids and their side effects.
Blood conservation, fluid balance and temperature control throughout the procedure.

After Surgery: The First Hours and Days

Early mobilisation. Most patients stand and walk with a physiotherapist on the day of surgery.
Eating and drinking early, rather than prolonged fasting.
Prompt removal of drips, drains and catheters, which are the things that most often keep people in bed.
A written pain plan so you stay comfortable enough to move and sleep.
Clot and infection prevention as part of the standard pathway.

Going Home

Discharge is decided by criteria, not by the calendar. You go home when you can move safely with your aids, manage stairs if you have them, control your pain with tablets, and look after yourself with the support you have arranged.

Depending on your operation and your health, that may be the same day, or after one or more nights. Your surgeon will discuss what is realistic for you.

What the “+” Adds

Prehab, not just preparation. A supervised program in the weeks before surgery, typically two to six weeks.
Objective measurement. Strength, balance, movement and body composition are measured before surgery and re-tested at milestones, so progress is a number rather than an impression.
One integrated team. Your surgeon and physiotherapist work to the same plan and the same milestones.
Digital follow-up. Exercises, instructions and progress tracking continue after you leave, through the Healthy Joints app and our Patient Portal.

What the Evidence Shows

Enhanced recovery pathways are associated with fewer complications — including infection, blood transfusion and readmission — without an increase in harm. Early mobilisation after joint replacement is supported by good-quality evidence and reduces length of stay with no significant difference in perioperative complications.

Evidence for prehabilitation is more mixed: it reliably improves fitness and confidence before surgery, but studies disagree on how much it changes outcomes afterwards. We are upfront about that, and we use objective testing so you can see what is actually changing for you.

Your Part in It

ERAS works best when you are an active participant rather than a passenger.

Complete your prehab program and keep moving in the lead-up to surgery.
Follow the fasting and medication instructions you are given.
Stop smoking if you can, and work with your GP on blood pressure, diabetes and weight.
Arrange help at home before you are admitted.
Get up and move as soon as you are asked to — it is safe, and it is the single most useful thing you can do.

Related Services & Information

Content reviewed by our orthopaedic surgery and physiotherapy teams. This information is general and does not replace personalised medical advice.