INTRODUCTION:
Total knee replacement (TKR) is a high-volume surgical intervention essential for restoring mobility and quality of life in ageing populations. Fragmented perioperative care pathways contribute to inequities in access, outcomes, and resource utilisation, particularly among older adults and patients with multimorbidity. This study presents an integrated clinical care pathway for TKR informed by public health principles and Enhanced Recovery After Surgery (ERAS) frameworks (1,3).

METHODS:
An integrated TKR clinical pathway was developed using a structured pathway development approach grounded in evidence-based practice, multidisciplinary consensus, and health systems performance frameworks (2). Parameters were systematically mapped across the full TKR care continuum and defined a priori within five domains: clinical safety and quality, functional recovery, process efficiency, equity and patient-centredness, and health system sustainability. Structure, process, and outcome indicators were specified for each phase of care to support standardisation, accountability, and future evaluation (2). Clinical parameters included comorbidity optimisation, venous thromboembolism and infection risk stratification, anaesthetic and analgesic strategies, and early mobilisation milestones (1,3). Process indicators incorporated time-based care targets, discharge readiness criteria, and multidisciplinary coordination (2). The pathway underwent external expert validation for clinical relevance and alignment with best practice (3).

RESULTS:
The process produced a comprehensive, end-to-end integrated care pathway encompassing pre-operative assessment, perioperative management, discharge planning, post-discharge rehabilitation, and long-term follow-up (2). The pathway embedded standardised safety parameters, early rehabilitation protocols, coordinated transitions of care, and patient-reported outcome monitoring (1,3). Equity and patient-centredness were operationalised through structured social assessment, inclusive education strategies, and individualised discharge planning (2). External expert review confirmed alignment with contemporary best practice, including ERAS principles (1,3).

CONCLUSIONS:
This integrated TKR pathway demonstrates how surgical services can be aligned with public health priorities of equity, inclusion, and sustainability (2). It provides a scalable, adaptable model for strengthening resilient, people-centred surgical systems in ageing populations (1,3).