Total knee arthroplasty (TKA), commonly known as knee replacement surgery, is a frequent procedure performed to treat severe arthritis and restore mobility. A primary concern for patients is the expected length of the hospital stay, which has significantly decreased due to advances in surgical and post-operative care protocols.
Typical Duration of Hospital Stay
The current standard for hospital stays following a total knee replacement is brief, typically ranging from one to three days. This is a significant reduction from the historical norm of five to seven days, largely due to improved surgical techniques and aggressive post-operative management.
The exact duration depends on several individual patient factors. A patient’s age and overall health status, particularly the presence of other medical conditions, influence how quickly they are ready for discharge.
The complexity of the surgery also plays a role in the recovery timeline. Unilateral procedures, involving only one knee, generally result in a faster recovery and shorter stay compared to bilateral replacements, where both knees are operated on simultaneously. The goal is to transition the patient out of the acute care setting as soon as they can safely manage their initial recovery at home or in a specialized facility.
Clinical Milestones for Discharge
A patient’s discharge from the hospital is based on achieving specific physical and clinical milestones. The primary requirement is achieving adequate pain control using oral medication, demonstrating that the patient no longer requires intravenous pain relief. Pain must be managed well enough for the patient to participate actively in physical therapy.
Mobility is a major factor, and patients must be able to get in and out of bed independently and safely transfer to a chair or commode. They are expected to demonstrate independent ambulation, meaning walking a short distance, such as 100 feet, using an assistive device like a walker or crutches.
Patients must also attain a minimum functional range of motion in the new knee, typically bending the knee to at least 90 degrees. They must be able to perform basic self-care tasks, such as dressing and managing personal hygiene. Finally, the patient needs to show they understand the instructions for incision care and recognize the warning signs of potential complications, such as infection.
The Impact of Enhanced Recovery Programs
The shift toward shorter hospital stays is closely tied to the widespread adoption of Enhanced Recovery After Surgery (ERAS). ERAS protocols are multidisciplinary pathways designed to accelerate recovery and minimize surgical stress on the body.
A core component of ERAS is multi-modal pain management, which involves using a combination of non-opioid medications, such as nerve blocks and anti-inflammatories, to control pain more effectively. This strategy reduces the reliance on opioid narcotics, which can cause side effects like nausea and sedation that delay mobilization.
Immediate post-operative mobilization is also a feature, with physical therapy often starting within hours of the surgery being completed. Early ambulation helps to restore function, reduce swelling, and decrease the risk of blood clots. For select, healthy patients with a strong support system, these refined protocols have made same-day or outpatient knee replacement a growing viability.
Planning for Post-Hospital Care
Post-hospital care is determined early in the recovery process, involving coordination between the surgical team and therapists. There are two main destinations for discharge: home with outpatient physical therapy or a specialized rehabilitation facility.
Discharge to a skilled nursing facility (SNF) or inpatient rehabilitation unit is generally reserved for patients who require more intensive, round-the-clock medical oversight or who have not met the necessary mobility milestones. The decision is heavily influenced by the patient’s support system at home, as those living alone or without reliable help may be better suited for a temporary stay in a facility.
The goal, regardless of the destination, is to ensure a safe transition that maintains the momentum of the patient’s recovery. Structured physical therapy is the primary focus of the weeks following discharge, whether performed at home or in a facility.