This study aimed to examine the influence of enhanced recovery after surgery (ERAS) application on postoperative recovery dynamics and safety profiles in elderly total knee arthroplasty (TKA) patients. A retrospective cohort analysis was performed on 400 individuals aged 65 years or older who underwent primary unilateral TKA between January 2022 and December 2023. According to perioperative management strategies, participants were divided into an ERAS group (n = 200) managed with a standardized