Over 52,000 total knee replacements were performed in Australia in 2016. Primary total knee replacement has increased by almost 140% since 2003. Osteoarthritis remains the most common reason for surgery with 97.6% of cases in the National Joint Replacement Registry in 2017. Revision rates of primary knee replacements at 16 years in the registry with osteoarthritis as the primary diagnosis is 8.0%. Despite these survival numbers the literature reports poor patient satisfaction rates of up to one in five cases (20%). While there is no clear algorithm to predict patient satisfaction, many factors have been examined. These include pre operative, intra operative and post operative factors. This paper will examine these and the influence that these factors may have on post operative long term patient satisfaction following total knee replacement.