Enhanced recovery after surgery for hip and knee arthroplasty: where is the evidence?

<span class="paragraphSection">Editor—Recently, Soffin and YaDeau<a href="#aex058-B1" class="reflinks">¹</a> published 'a review of the evidence' of enhanced recovery after surgery (ERAS) for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Although admittedly a narrative review, the review is not up to date, and at several points does not present 'the evidence'. For instance, a lot of space is used on fasting, carbohydrate loading, antimicrobial prophylaxis, and metabolic responses (all of which have no or limited effects on ERAS in these specific procedures). However, the review did not mention the more important recent research on the role of the inflammatory response for recovery<a href="#aex058-B2" class="reflinks">²</a> and its modification by high-dose steroids.<a href="#aex058-B3" class="reflinks">³</a><a href="#aex058-B4" class="reflinks">⁴</a> Also, the statement that epidural analgesia is to be recommended is against the evidence for many years.</span>

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