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Abstract Purpose Total knee arthroplasty (TKA) combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate isokinetic knee muscle strength after cemented TKA in combination with an enhanced recovery after surgery (ERAS) compared to a conventional setup. Methods In the single blinded prospective randomized study, 52 patients underwent navigated primary cemented TKA within an ERAS (n = 30) or a conventional setup (n = 22). Preoperatively, five days and four weeks after surgery isokinetic knee muscle strength with BIODEX‐type measuring device (peak torque in Nm, work in Joules and power in Watt) and subjective patient‐related outcome measures (PROMs) were investigated. Results The ERAS group showed significantly better outcomes in knee flexion at 180°/s (peak torque (Nm) p = 0.047, work (J) p = 0.040 and power (W) p = 0.016) 5 days postoperatively. The isokinetic measuring at knee extension 60°/s and 180°/s demonstrated no significant difference. The PROMs showed that patients were satisfied with the postoperative results in both groups. After 4 weeks, there was no longer a significant difference in isokinetic measuring at knee extension and flexion between the ERAS and conventional group. Conclusions TKA with the concept of ERAS improves excellent isokinetic outcome and patient satisfaction. The isokinetic muscle strength measurement can help patients and surgeons to modify expectations and improve patient satisfaction.

Abstract Purpose Although total hip arthroplasty (THA) is expected to result in a postoperative loss of muscular strength, no study investigated the benefit of an enhanced‐recovery‐after‐surgery (ERAS) concept on the hip muscles in detail. We evaluated if (1) an ERAS‐concept for primary THA results in reduced loss of muscular strength five days and four weeks postoperative. We (2) compared the two groups regarding Patient‐Related‐Outcome‐Measures (PROMs), WOMAC‐index (Western‐Ontario‐and‐McMaster‐Universities‐Osteoarthritis‐Index), HHS (Harris‐Hip‐Score) and EQ‐5d‐3L‐score. Methods In a prospective, single‐blinded, randomized controlled trial, we compared isokinetic muscular strength of 24 patients receiving primary THA with an enhanced recovery concept with early mobilization (n = 12, ERAS‐group) and such receiving conventional THA (n = 12, non‐ERAS). Isokinetic muscular strength was measured with a Biodex‐Dynamometer before, as well as five days and four weeks after surgery (peak‐torque, total‐work, power). Furthermore, WOMAC, HHS, PROMs and EQ‐5d‐3L were imposed. Results The ERAS group revealed significant higher isokinetic strength (peak‐torque, total‐work, power) at both time points. Both groups showed a significant pain decrease at both time points meeting very high rates of patient satisfaction resembled by good results in PROMs, WOMAC, HHS, EQ‐5d. There was no significant difference in any of the scores between both groups. Conclusion We proved a significant reduced loss of muscular strength five days and four weeks after primary THA in combination with an ERAS concept. However, the reduced loss of muscular strength is not reflected by patient’s functional outcome and quality of life, showing no significant differences in WOMAC, HHS, EQ‐5d‐3L, PROMs and NRS. Therefore, this study supports the implementation of an ERAS concept for primary THA in terms of isokinetic strength. Further studies are needed to evaluate the development of muscular strength over a long period.