Three hundred twenty adult patients undergoing elective primary total knee arthroplasty were randomized to receive either an ERAS-based perioperative management protocol (n = 155) or conventional care (n = 158). The primary outcome of interest was total length of hospital stay (LOS). Secondary outcomes included postoperative LOS, time to independent ambulation, postoperative pain at rest and during mobilization, postoperative thirst, PONV, and complication rates. Outcomes were assessed throughout the hospitalization period and up to 30 days postoperatively. Overall, the results of the study revealed that the ERAS pathway significantly reduced total LOS, postoperative pain, and incidence of thirst and PONV, while also promoting earlier ambulation without increasing complication rates. These findings suggest that ERAS protocols can effectively enhance recovery and reduce hospitalization time following TKA.