The integration of enhanced recovery after surgery (ERAS) principles with high-conformity total knee arthroplasty (TKA) technology provides a novel strategy for improving clinical outcomes and patient satisfaction following TKA. As a personalized and patient-specific prosthetic solution, high-conformity knee implants can more accurately match the individual anatomical morphology of the diseased knee joint than conventional prostheses, thereby maximizing postoperative functional restoration. However, standardized clinical protocols and unified management pathways for high-conformity TKA within an ERAS framework remain lacking in China. To standardize clinical practice and promote precision-based and homogeneous management, this consensus was developed by a multidisciplinary panel of Chinese experts in joint arthroplasty and related fields. A modified Delphi methodology was adopted. Relevant domestic and international literature was systematically reviewed, and an initial draft was developed based on the best available evidences and clinical experiences in China. Subsequently, two rounds of expert questionnaires and one round of online expert discussions were conducted to evaluate, revise, and refine the proposed statements, culminating in the final consensus. Consensus was defined as an agreement rate of ≥85% and categorized as strong consensus (95.0%-100%), general consensus (90.0%-94.9%), and moderate consensus (85.0%-89.9%). This consensus provides recommendations on key aspects of high-conformity TKA within an ERAS pathway, including preoperative precision assessment, multimodal imaging evaluation, patient selection, personalized implant design and accurate implantation, perioperative management, pain control, functional rehabilitation, and long-term follow-up. The objective is to offer practical guidance for orthopedic surgeons and rehabilitation specialists, facilitate the standardized implementation of high-conformity TKA integrated with ERAS protocols, optimize perioperative care, and ultimately improve functional recovery and quality of life for patients undergoing TKA.
With the growing demand for total knee arthroplasty (TKA) in patients with end-stage knee osteoarthritis, the integration of minimally invasive surgical concepts with high-conformity personalized prosthesis design has become an important strategy for improving surgical precision and postoperative outcomes. However, standardized clinical pathway guidance for this combined approach remains lacking. Therefore, based on the current body of evidence and through multicenter expert collaboration, this consensus aims to establish a standardized clinical application protocol. The consensus focuses on the technical characteristics of high-conformity prostheses and the principles of mechanical alignment, and systematically develops a comprehensive clinical pathway covering preoperative digital planning, intraoperative precision techniques, and postoperative rehabilitation and follow-up. By standardizing patient selection criteria, refining imaging-based modeling and individualized prosthesis design procedures, optimizing osteotomy accuracy and soft tissue preservation under minimally invasive conditions, and establishing a follow-up system centered on functional baseline comparison and image-based matching verification, this consensus ultimately proposes a closed loop quality management framework spanning preoperative assessment, intraoperative implementation, and postoperative evaluation. It is expected to provide practical guidance for the safe and effective clinical application of high-conformity TKA performed through minimally invasive approaches.