Recent evidence shows the advantages of carbohydrate loading in major surgeries especially gastrointestinal surgeries. The pathophysiological and metabolic changes in response to surgery can be diminished by introducing ways of decreasing inflammatory and metabolic response including insulin resistance. Patients undergoing total knee replacement surgeries are at a high risk for developing perioperative metabolic derangements and complications due to the advanced age and associated comorbidities. We expect that a simple measure like decreasing the fasting time and carbohydrate loading will decrease the metabolic and endocrine derangements by decreasing the insulin resistance, decreasing the inflammatory response. It will also decrease patient discomfort by reducing thirst, dehydration, hunger, pain and anxiety. Reduced protein catabolism will lead to improved muscle strength, decreased weakness and help in early ambulation.

Positive outcomes of the study will encourage introduction of a simple, efficacious and inexpensive clinical intervention in patients undergoing this major orthopedic surgery which demands early recovery and ambulation. Patients will have increased satisfaction without the risk of aspiration, decreased post-operative complications leading to early discharge and reduced length of hospital stay.