Studies show that high-volume surgeons operating at high-volume hospitals have the best results with total knee replacements (TKRs).
Presumably this means that doctors who do the surgery more often have better results. Care given at high volume teaching or university hospitals seems to come with lower death rates and fewer infections.
Exactly what the differences are between high and low volume hospitals remains to be investigated. Hospital resources and clinical pathways (the way they do things) may be the difference. More study is needed to sort out which aspects of care delivered at high volume institutions results in better outcomes.
For now the results of these studies suggest choosing your surgeon is the first and most important step. Taking a look at the type and size of hospital may also be important. Family support is a final factor that should be included in your decision. If your family can't travel to be with you at the larger hospital, then the local hospital may be the trade off needed to ensure the best care all around.