Quiet recovery in knee arthroplasty: Does a minimalist protocol enhance early satisfaction without sacrificing function?

Background: Enhanced recovery after surgery (ERAS) protocols dominate total knee arthroplasty (TKA) rehabilitation, championing aggressive early mobilization. While enhanced recovery protocols have improved functional recovery after TKA, some patients continue to experience substantial early postoperative discomfort during intensive early rehabilitation. This study investigates a “quiet recovery” alternative a minimalist protocol emphasizing protective rest via night-time bracing and fundamental exercises to determine if early satisfaction can be enhanced without sacrificing functional gains. Materials and Methods: In a prospective consecutive cohort study, 186 patients undergoing primary TKA received either a standard ERAS protocol or the minimalist protocol (night-time bracing, five basic exercises for 15 days). Primary outcome was pain reduction (0–20 Numerical Rating Scale). Secondary outcomes included Knee Society Score (KSS), WOMAC, range of motion (ROM), and satisfaction at 6 weeks. Analysis utilized unpaired t -tests and Chi-square tests. Results: The minimalist group achieved dramatically greater pain reduction (8.33 ± 2.57 vs. 4.99 ± 3.38, P < 0.001) and superior functional improvement (ΔWOMAC: 22.7 vs. 6.2, P < 0.001; KSS: 48.1 ± 8.2 vs. 32.5 ± 9.7, P < 0.001). Critically, ROM was equivalent (110° ± 11° vs. 112° ± 9°, P = 0.214). Patient satisfaction was 28% higher in the minimalist cohort ( P < 0.001), with no difference in complication rates. Conclusion: A ”quiet recovery” protocol significantly improves early pain control and patient satisfaction without compromising functional recovery or mobility. By aligning postoperative care with biological healing principles reducing early inflammatory exacerbation, this approach offers a compelling, patient-centered alternative to aggressive ERAS pathways.