OBJECTIVES: Recent reductions in length of hospital stay after TKA have resulted in an increased demand on extended care facilities (ECF) to manage TKA postoperative care.  An exponential increase in TKA procedures is expected by 2030 and a shortage of resources to meet the increase is projected. Determining what factors affect patients to be discharged directly home or to rehabilitation may assist resource allocation decisions.    The objective of this study was to identify if preoperative patient characteristics (age, gender, comorbidities, physical function and activity) were associated with discharge to an ECF versus discharge directly home after an elective TKA. METHODS: Patients ≥40 years old with a primary unilateral TKA, excluding those with a 2nd  TKA surgery within the year, were retrospectively extracted from a clinical orthopedic database between Septeber 1, 2008 – November 30, 2010. Discharge location and preoperative comorbidities (diabetes, hypertension, obesity [bmi >30 kg/m2], cancer, osteoporosis, chronic back pain, insomnia, osteoporosis) were obtained by chart abstraction from the electronic medical record. Using logistic regression analysis, odds ratios were adjusted for age, gender, preoperative patient education, levels of preoperative physical health and activity and insurance type (medicaid, medicare, private). RESULTS: A total of 174 patients with average age 63.8 years (SD 10.2, 41-85) were included in the study. Overall, one-third of patients (35.6%, 62) of patients were discharged to a ECF. In adjusted ORs, the likelihood of going to a ECF postoperatively were 3.23 times (95% confidence interval[CI]=1.27-8.16) more likely for those age ≥65 years compared to those <65 years; 2.86 times (95% CI =1.11-7.37) in patients with a diabetes and 2.99 (95% CI =1.15-7.80) times for those with a cancer diagnosis compared to those without diabetes and cancer, respectively.  CONCLUSIONS: We identified specific patient variables that may predict postoperative discharge destination.  Identification is paramount to avoid delays in patient discharge and to efficiently manage available resources.