SAME-DAY SURGERY CANDIDACY · RISKS AND TRADE-OFFS · FRANKLIN, TN
Hospital or Surgery Center for Knee Replacement in Tennessee - How to Decide
For most healthy adults, total knee replacement at an ambulatory surgery center is as safe as in a hospital, with a shorter facility stay, lower infection exposure and recovery at home the same day. A hospital is the right setting when your heart, lungs, kidneys or home situation make overnight monitoring the safer choice. Dr. Cory Calendine makes that call with you at your consultation, based on a specific checklist, not on the schedule.
On this page
THE BRIEF ANSWER
Who Has Surgery Where - The Brief Version
| Comparison point | Bone and Joint Institute of Tennessee Surgery Center | Williamson Medical Center (hospital) |
|---|---|---|
| Who it's for | Healthy adults with well-controlled medical conditions and help at home | Patients with significant cardiac, pulmonary or kidney disease, severe sleep apnea, or no home support |
| Length of stay | Home the same day, usually within 4 to 6 hours of arrival | One night or more, based on medical need |
| The surgery | Identical: same surgeon, same implant, same subvastus and Mako robotic technique | Identical |
| Anesthesia | Spinal with regional blocks; general when needed | Same options, plus ICU-level backup |
| Infection exposure | Orthopedic-only facility; no medically complex inpatients on site | Mixed-use hospital; higher baseline exposure |
| Monitoring after surgery | Recovery room, then home with a caregiver and a direct line to the on-call team | Overnight nursing, labs and physician rounds |
| If something goes wrong | Hospital is next door on the same campus; transfer protocol in place | Already there |
| Facility cost to Medicare | Lower (see the cost page) | Higher |
| Location | 3000 Edward Curd Lane, Suite 100, Franklin, TN 37067 | 4321 Carothers Parkway, Franklin, TN 37067 |
WHAT THE RESEARCH SHOWS
What the Evidence Says - Honestly
Same-day knee replacement is not a shortcut. It became possible because four things improved at once: spinal anesthesia with long-acting local injections around the joint, multimodal pain control that reduces opioid need, tranexamic acid to limit blood loss, and muscle-sparing surgical approaches that let patients stand and walk within hours.
Studies comparing same-day and inpatient knee replacement in properly selected patients have generally found similar complication and readmission rates [1-3]. Some large database analyses have found more complications after same-day surgery, particularly when compared with short inpatient stays [4, 5], which is exactly why selection matters.
The phrase that matters is “properly selected.” The outpatient results are good because the patients were chosen for it. When a surgeon sends a poor candidate home the same day, the setting did not fail; the selection did. That is why the checklist below is the real content of this page.
From Dr. Calendine
“I reassure every patient that the operation is identical, hip or knee, whether we do it in the hospital or at the surgery center. We mobilize you and recover you the exact same way. The facility differences are a matter of convenience and patient flow. The same level of care and the same low complication rate exist in both places.”
THE CANDIDACY CHECKLIST
The Checklist Dr. Calendine Uses to Decide
Strong candidates for same-day surgery at the BJIT Surgery Center
- Generally good overall health, without uncontrolled heart, lung or kidney disease
- No untreated or severe obstructive sleep apnea
- Blood sugar under control if you have diabetes
- Body weight in a range that keeps infection risk low. Dr. Calendine works with patients toward a body mass index near 40 or below before same-day surgery, but this is individualized to the patient, not a cutoff
- Able to walk before surgery, with or without a cane or walker
- A responsible adult at home for the first 24 to 48 hours
- A home you can move through safely: a manageable number of steps, an accessible bathroom, clear walking paths
- Willing to follow the pre-operative plan and the first-week recovery instructions
A prior blood clot does not by itself rule out the surgery center. Most patients go home on low-dose aspirin twice a day to prevent clots; patients with higher clotting risk are given a stronger blood thinner, and that plan is set before surgery in either setting.
WHEN THE HOSPITAL IS SAFER
Who Should Not Have Same-Day Knee Replacement at a Surgery Center
Williamson Medical Center, the hospital of the Williamson Health system, is the safer choice when any of the following applies:
- Significant coronary disease, heart failure or a recent cardiac event
- Advanced COPD or oxygen dependence
- Kidney failure or dialysis
- Severe obstructive sleep apnea, especially if untreated
- Living alone without a caregiver for the first two days
- A history of complications with anesthesia
- Any condition where Dr. Calendine wants overnight labs and nursing observation
Age by itself is not on either list. Dr. Calendine performs same-day knee replacement for patients in their 70s and 80s when their health profile supports it, and admits younger patients when it does not.
From Dr. Calendine
“It’s not so much about age. It’s very much about overall health. We’re careful, and a full medical assessment decides the best location for each patient. The more medically complex patients have surgery at the hospital. Our same-day surgery center is across the parking lot from the main hospital, so a higher level of care is immediately available if it’s ever needed.”
TRADE-OFFS
What a Surgery Center Can and Cannot Do
What it does better: single-purpose orthopedic facility, the same surgical team every case, no emergency cases bumping your start time, parking steps from the door, lower infection exposure, and a recovery that starts in your own bed.
What it cannot do: admit you overnight, run an intensive care unit, or manage an unexpected medical event beyond stabilizing you. That is why candidate selection is strict and why the hospital is next door. If a patient at the BJIT Surgery Center needs overnight care, the transfer is a short one on the same campus.
What is the same in both: the surgeon, the implant, the surgical approach, the robotic planning and the physical therapy plan. Choosing the surgery center does not mean choosing a lesser version of the operation.
From Dr. Calendine
“It’s all about expectations. Knowledge is power. Good education, being ready, and having the house set up eases those nerves, and it’s nice to have family support for the first couple of days. Because of the nerve blocks, you’re often more comfortable on the day of surgery than on day two or three, so getting home that day is sometimes the easier part. Plus, you sleep in your own bed.”
TENNESSEE SPECIFICS
Knee Replacement Surgery Centers in Tennessee - What's Changing
Tennessee has fewer freestanding orthopedic surgery centers than many states because, until recently, opening one required a certificate of need from the state. That requirement for ambulatory surgery centers is scheduled to sunset on December 1, 2027, after which new centers will still need state licensure but not CON approval. Expect more orthopedic surgery centers to open across Middle Tennessee over the next several years.
The Bone and Joint Institute of Tennessee Surgery Center opened in 2020 as a joint venture between the Bone and Joint Institute of Tennessee’s physicians and Williamson Medical Center. It has six operating rooms and 25 pre- and post-operative beds, is accredited by The Joint Commission, and sits on the Williamson Medical Center campus at 3000 Edward Curd Lane, Suite 100, Franklin, TN 37067, about 20 miles (25 minutes) south of downtown Nashville on I-65, Exit 65. It serves patients from Nashville, Brentwood, Franklin, Nolensville, Spring Hill, Columbia and Murfreesboro.
SURGERY DAY
What the Day Looks Like
Surgery center: arrive early morning, spinal anesthesia and blocks, 60 to 90 minutes of surgery, two to three hours in recovery with a physical therapist, home by early afternoon with written instructions and the on-call number. The full timeline is on the outpatient joint replacement page.
Hospital: the same morning and the same operation. The difference begins in the afternoon: a room, overnight nursing, labs the next morning, and physician rounds before discharge on day one or two. Physical therapy starts the day of surgery in both settings.
You arrive at the BJIT Surgery Center, complete final paperwork, and meet the surgical team. A family member can stay with you through pre-op preparation.
The anesthesia team places your spinal anesthesia and any regional nerve blocks. You receive tranexamic acid to minimize blood loss. Dr. Calendine reviews the surgical plan with you one final time.
Knee replacement is performed using your personalized surgical plan, with Mako robotic-assisted precision when indicated.
You wake up in the recovery area, your spinal anesthesia begins to wear off, and the physical therapy team gets you standing and walking a short distance. Pain control is reassessed before discharge.
You leave with a clear medication plan, written instructions, your physical therapy schedule, and direct contact information for the on-call team. A family member or friend drives you home.
AFTER YOU GO HOME
When to Call After Same-Day Knee Replacement
You go home with the on-call number and written instructions. Call it, day or night, for any of these:
- Calf pain, or new swelling in the calf or thigh
- Chest pain, shortness of breath or a racing heartbeat (call 911 first, then us)
- Fever, or chills that do not settle
- Drainage from the incision after the first two days, or redness spreading away from it
- Pain that the medication plan is not controlling
- A fall, or a knee that suddenly will not bear weight
None of these means something has gone wrong, but each one is a reason to talk to the team the same day rather than wait for your follow-up visit.
COST, BRIEFLY
Does the Setting Change What You Pay?
For Medicare, the 2026 facility payment for a total knee replacement is $9,393 at a surgery center versus $13,117 at a hospital outpatient department. For a traditional Medicare patient, your own out-of-pocket share is similar in both settings because Medicare caps hospital outpatient coinsurance at the Part A deductible; for commercially insured and self-pay patients, the surgery center is usually meaningfully less expensive. The details, with sources, are on How Much Does Outpatient Knee Replacement Cost in Nashville and Franklin, TN?.
CHOOSING A SETTING
Frequently Asked Questions About Choosing a Setting
Can I have a knee replacement at a surgery center instead of a hospital in Tennessee?
Yes, if you are a good candidate. Medicare and most commercial plans cover total knee replacement at an ambulatory surgery center. Dr. Calendine performs most of his knee replacements at the Bone and Joint Institute of Tennessee Surgery Center in Franklin, TN, and uses Williamson Medical Center next door for patients who need an overnight stay.
Is a surgery center as safe as a hospital for knee replacement?
For properly selected patients, yes. Studies of same-day knee replacement in healthy adults have generally found complication and readmission rates similar to inpatient surgery. The safety depends on the selection: patients with significant heart, lung or kidney disease, severe sleep apnea, or no help at home are safer in the hospital.
What happens if there is a problem after surgery at the surgery center?
You are monitored in recovery until you meet discharge criteria: pain controlled, walking safely with the physical therapist, and stable vital signs. If you need overnight care, Williamson Medical Center is on the same campus and the transfer protocol is already in place. Once home, you have a direct line to the on-call team.
Who decides whether I go to the surgery center or the hospital?
Dr. Calendine, with you, at your pre-operative visit. The decision is based on your medical history, your mobility, your home support and any anesthesia concerns. It is never made to fill a schedule or to save money.
Am I too old for same-day knee replacement?
Age by itself does not decide it. Overall health does. Dr. Calendine performs same-day knee replacement for patients in their 70s and 80s when a full medical assessment supports it, and admits younger patients to the hospital when it does not.
PRACTICAL QUESTIONS
Practical Hospital & Surgery Center Questions
How far is the BJIT Surgery Center from Nashville?
About 20 miles (25 minutes) south of downtown Nashville on I-65, Exit 65, on the Williamson Medical Center campus in Franklin, TN. Most patients from Nashville, Brentwood and Murfreesboro drive 25 to 40 minutes.
Do I need someone to stay with me after same-day knee replacement?
Yes. A responsible adult must drive you home and stay with you for the first 24 to 48 hours. If that is not possible, an overnight hospital stay is the safer plan.
Will my recovery be different if I have surgery in the hospital?
No. The surgery, the implant, the surgical technique and the physical therapy plan are the same. The only difference is where you spend the first night.
Does the hospital versus surgery center choice affect which surgeon I get?
No. Dr. Calendine operates in both settings on the same campus.
References
- Bemelmans YFL, Keulen MHF, Heymans M, van Haaren EH, Boonen B, Schotanus MGM. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022;142(8):1775-1791. PMID 33587170. pubmed.ncbi.nlm.nih.gov
- Ponugoti N, Magill H. Safety, efficacy and cost-effectiveness of outpatient versus inpatient joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26(1):349. PMID 40200196. pubmed.ncbi.nlm.nih.gov
- Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature. JBJS Rev. 2016;4(12):e4. PMID 28060788. pubmed.ncbi.nlm.nih.gov
- Bordoni V, Poggi A, Zaffagnini S, Previtali D, Filardo G, Candrian C. Outpatient total knee arthroplasty leads to a higher number of complications: a meta-analysis. J Orthop Surg Res. 2020;15(1):408. PMID 32928278. pubmed.ncbi.nlm.nih.gov
- Li M, Luo R, Zeng Y, Wu Y, Liu Y, Wu L, Shen B. Same-day discharge arthroplasty has a higher overall complications rate than fast-track arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2022;142(6):1167-1176. PMID 34129118. pubmed.ncbi.nlm.nih.gov
- Centers for Medicare & Medicaid Services. Ambulatory Surgical Center Payment System, CY 2026 Addendum AA (CPT 27447, $9,393.16). cms.gov
- Centers for Medicare & Medicaid Services. Hospital Outpatient Prospective Payment System, CY 2026 Addendum B (CPT 27447, APC 5115, $13,116.76). cms.gov
- Zimmer Biomet. New Medicare Policy Allows Payment to ASCs for Total Knee Arthroplasty (ASC coverage effective January 1, 2020). zimmerbiomet.com (PDF)
- Becker’s ASC Review. Joint venture ASC in Tennessee logs 1st case (BJIT Surgery Center opening, ownership, facility size). beckersasc.com
- Tennessee Health Facilities Commission. Basic Information on the Certificate of Need Program. tn.gov
- Holland & Knight. Tennessee Passes Legislation to Modify the State’s Certificate of Need Rules (HB 2269, 2024). hklaw.com
- Williamson Medical Center. Emergency Department page (hospital address). williamsonmedicalcenter.org
Watch: Hospital or Surgery Center for Your Knee Replacement?
SCHEDULE A CONSULTATION
Not Sure Which Setting Is Right for You?
That is exactly what the consultation is for. Dr. Calendine will review your X-rays, your medical history and your home situation and tell you plainly which setting he recommends and why. Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067.
Related: Surgery Center for Joint Replacement Near Nashville
Real Patients, Real Experiences
I had a setback regarding my photo ID/Dr License were expired however I am in process of getting them renewed when I get new state Identification card They will apply it to my chart file.