Joint replacement surgery aims to reduce pain, improve mobility and quality of life. Demand for such surgeries, particularly for lower limb joint replacement, is increasing with an ageing population. Osteoarthritis is the commonest indication, and up to 20–30% of these patients have significant medical comorbidities that necessitate a comprehensive and careful perioperative care.

Multidisciplinary enhanced recovery protocols have been implemented to improve outcomes and accelerate patient recovery. Anaesthetists should focus on interventions that reduce perioperative stress and maintain normal physiological function. Some important aspects include preoperative optimization, perioperative multimodal analgesia, opioid sparing, prevention of postoperative nausea and vomiting (PONV), early mobilization, resumption of diet and venous thromboembolism (VTE) prophylaxis.1