Total Hip Replacement ERAS

Enhanced Recovery After Surgery (ERAS) programs promote an evidence-based, multidisciplinary approach to patient care that facilitates faster recovery from surgery, reduces hospital length of stay, and minimizes post-operative complications. From scheduling through discharge, all phases of perioperative care are incorporated into ERAS programs.

ERAS Pathway: 

• Total Hip Replacement: Prior to Surgery Day Algorithm
• Total Hip Replacement: Intraoperative Algorithm
• Total Hip Replacement Synopsis – provides care standards employed for this clinical pathway  

Additional tools associated with this Clinical/ERAS Pathway: 

• ERAS overview handout – English 
• ERAS overview handout - Spanish  

Neuraxial Anesthesia Inclusion and Exclusion Criteria: 

• Inclusion:
  • Patient consent, surgery below the umbilicus requiring motor and sensory blockade  

• Exclusion: 
  • Absolute contraindications: Patient refusal, systemic infection or infection at the site, history of bleeding disorder (hemophilia, thrombocytopenia, etc.), patients on anticoagulant therapy (warfarin, heparin, etc.), allergy to medications, inability to cooperate or position for the procedure, conditions that increase intracranial pressure (brain tumor, trauma, intracranial bleed), uncorrected hypovolemia.
  • Relative contraindications: Pre-existing neurological disease such as multiple sclerosis, neuropathy, spinal cord disease, extreme obesity, cognitive impairment, aortic stenosis, or a fixed cardiac output, severely uncontrolled hypertension, scoliosis, or history of spinal surgery.  

Committee members involved in the development: 

• Anne Kancel, DO | Anesthesiology | Committee Chair
• Chris Halphen, DO | Orthopedic Surgery | Committee Member 
• Emily Weisburg, MD | Anesthesiology | Committee Member 
• Erin Adams, MD | Anesthesiology | Committee Member 
• Heather Sambol, RN, APRN | Anesthesiology | Committee Member 

EBP Committee Members 

• Todd Glenski, MD, MSHA, FASA | Anesthesiology, Evidence Based Practice 
• Andrea Melanson, OTD, OTR/L | Evidence Based Practice 

 Publication dates: 

• Finalized date: 2/2026 
• Next expected revision date: February 2026 

 Concerns with content: 

If you have any questions regarding this content or identify a broken link, please email evidencebasedpractice@cmh.edu.  

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.