Total knee arthroplasty (TKA), also known as total knee replacement (TKR), is an elective joint surgical management and became a common procedure worldwide [1]. With its high success rates, the numbers of TKA among older adult patients increased, especially in the Middle Eastern region [2]. The primary advantage of this procedure is alleviating joint pain and improving mobility for patients suffering from advanced-stage osteoarthritis [3]. Fortunately, more recent articles suggested that just 4% to 7% of patients were dissatisfied with the results of their total knee replacement [4].   An increasing number of total knee arthroplasty (TKA) treatments performed in the United States exceeded 700,000 in 2012, with expected growth of up to 3.5 million procedures completed by 2030 [5]. A prospective cohort study published in 2019 on patient satisfaction with primary total knee replacement in Sulaimani City reported that 71.7% of the patients were satisfied [3]. In 2022, a cross-sectional study was conducted on patient satisfaction and quality of life in Saudi Arabia toward total knee replacement and total hip replacement surgeries, showing a high satisfaction rate for joint replacement surgeries [6]. In 2020, a retrospective cohort study was published on the correlation between radiographic severity of arthritis and patient satisfaction toward total knee replacement, showing patients with severe arthritis had an overall satisfaction rate of 96% compared with 82% in mild arthritis [7].   Undoubtedly, TKR represented one of the most frequent orthopedic procedures globally and proportionally grew over time due to the apparent increase in the underlying risk factors [8]. Notably, primary TKA cases were projected to climb to 85% by 2030 [9]. By the end of 2030, 3.48 million TKR procedures were anticipated to have been performed worldwide [10]. Accordingly, given the growing number of knee replacements and the associated collateral effects, measuring how satisfied targeted people are and understanding potential TKA outcomes become increasingly important [11]. Thus, this study was primarily conducted to assess the level of satisfaction with TKA in Saudi Arabia. Our study aimed to evaluate patient satisfaction with TKA in Saudi Arabia and determine how it affects their daily life activities. We also aimed to identify preoperative and postoperative predictors of patient satisfaction after TKA.   Objectives The objectives of this research were to establish quantitative data regarding the satisfaction level and quality of life post-TKA among the population in Saudi Arabia, determine the impact of TKA among people in Saudi Arabia, and identify potential predictors of patient satisfaction and QoL in the preoperative and postoperative phases of TKA.

Study Design A cross-sectional study was conducted among the population of Saudi Arabia. The study involved a questionnaire that was filled out by researchers and data collectors.   Study Population This study included adult male and female patients who underwent TKA in Saudi Arabia.   Recruitment Individuals from the general population were invited to participate in the study voluntarily. Patient data were collected through structured interviews.   Sampling Procedure A conventional sampling technique was employed.   Inclusion and Exclusion Criteria Inclusion criteria Patients of all age groups and both genders underwent TKA (citizen and resident populations in Saudi Arabia).   Exclusion criteria All orthopedic arthroplasty procedures excluding TKR.   Sample Size Using the Qualtrics calculator with a 95% degree of confidence, the estimated minimum sample size was determined to be 384. The formula used to calculate the sample size was:   n=P(1−P)∗Zα2/d2n = P(1−P) * Zα² / d²   Method for Data Collection and Instruments (Data Collection Technique and Tools) Researchers and data collectors were deployed in four main regions: the Northern, Southern, Eastern, and Western regions. We interviewed the patients who had undergone TKA in clinics. We then reached out to them, and administered the Arabic version of the questionnaire. The questions were presented in the local language to ensure honest responses. The survey was divided into three parts, adapted from previous research [6]. The first part covered demographic information such as age, BMI, and education level. The second part included five questions focused on patient satisfaction. Lastly, the third part was the widely recognized SF-12 questionnaire, a validated standard for measuring quality of life.   Scoring System The second section consisted of five questions, with a total of eight possible points (Yes = 1, No = 0, Very highly = 4, Highly satisfied = 3, Moderately = 2, Minimally = 1, Not satisfied at all = 0).0–4 = Not satisfied, 5 = Moderately satisfied and 6–8 = Highly satisfied. The scoring of the third section followed Ware and his colleagues’ methodology [12].   Analysis and Entry Method Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (Chicago, IL, USA). Mean and standard deviation for quantitative variables and counts (%) for qualitative variables were used to summarize the data, with a level of significance set at p ≤ 0.05.

Table 1 displays various demographic parameters of the participants with a total number of 228. Participants' mean age stands at 57.9 years while 29.4% of participants are 54 years old or younger, indicating that middle-aged individuals form the majority who show relevance to chronic illness-related factors. The research sample reveals that females who join studies outnumber males 59.2% to 40.8% due to potential industry practices that tend to draw a primarily female participant base. Survey findings indicate that marriage exists among a greater portion of 67.1% of respondents relative to other marital statuses because social networks are likely to support their health outcomes after knee joint surgery. The study shows high numbers of persistent medical conditions with diabetes mellitus 42.9% followed by hypertension 37.7% while most patients received one knee joint replacement procedure 87.3%. The study population consists mainly of educated participants since 35.1% of them hold a bachelor's degree which enables researchers to perform detailed examinations of how education impacts health literacy and treatment compliance.   Table 1: Sociodemographic Characteristics of Participants (N=228) Parameter No. Percent (%) Age (Mean:57.9, STD:7.7) 54 years or less 67 29.4 55 to 59 66 28.9 60 to 65 54 23.7 66 or more 41 18.0 Gender Female 135 59.2 Male 93 40.8 Residential region Northern region 44 19.3 Southern region 10 4.4 Central Region 89 39.0 Eastern Region 10 4.4 Western Region 75 32.9 Educational level Primary school 17 7.5 Middle school 33 14.5 High school 69 30.3 Bachelor’s degree 80 35.1 Master’s 15 6.6 PhD 2 .9 Uneducated 12 5.3 Marital status Single 1 .4 Married 153 67.1 Divorced 19 8.3 Widowed 28 12.3 Separated 27 11.8 Chronic illnesses * Hypertension 86 37.7 Diabetes mellitus 98 42.9 Ischemic heart disease 10 4.4 Cardiomyopathy 6 2.6 Hypothyroidism 29 12.7 Asthma 30 13.2 None 68 29.8 Others 4 1.8 Type of surgery One knee joint replacement 199 87.3 Both knee joint replacement 29 12.7 Surgery date <1 year and more than 3 months 64 28.1 1 year 87 38.2 2 years 51 22.4 3 years 14 6.1 More than 3 years 12 5.3 Height in cm (Mean:165.9, STD: 9.2) 160 or less 82 36.0 161 to 169 52 22.8 170 to 175 52 22.8 176 or more 42 18.4 Weight in kg (Mean: 88.3, STD:14.3) 84 kg or less 70 30.7 85 to 90 88 38.6 91 kg or more 70 30.7 *Results may overlap   As shown in Figure 1, Information and indicators of success in overall joint replacement treatments emerge from the data presented in the figure. A substantial 88.1% of the respondents scored their joint replacement outcomes highly positive with "very highly satisfied" (76 respondents) and "highly satisfied" (106 respondents). Overall these two categories represent 36.6% and 51.5% of all respondents. A combined total of 88.1% of participants stood content with their results from joint replacements. The survey results showed that 16.8% of participants selected "moderately satisfied" and "minimally satisfied" and "not satisfied at all" received responses from 35 (16.8%) 8 (3.9%) and 3 (1.5%) respectively. Two out of every ten patients reported being dissatisfied with their joint replacement surgery but the large majority of 88.1% expressed satisfaction demonstrating a positive attitude toward this surgical intervention.     Figure 1: Illustrates Satisfaction with Joint Replacement among Participants   Table 2 shows that surgical outcomes proved effective at enhancing life quality based on the 79.8% of patients who expressed "very highly satisfied" and "highly satisfied" satisfaction levels. The surgical intervention received support from patients who indicated their intention to repeat the same procedure because they trusted the treatment. The study results reveal major functional improvements because surgery helped people improve their physical capabilities 86.4% and almost all subjects 94.7% noticed decreased pain post-treatment. The patient population showed strong approval of total knee replacement surgery by recommending it at an 88.6% rate which demonstrates that this procedure meets their needs successfully.   Table 2: Parameters Related to Satisfaction with Total Knee Surgery Replacement (N=228) Parameters No. Percent (%) How satisfied are you with your joint replacement? Very highly satisfied 76 33.3 Highly satisfied 106 46.5 Moderately satisfied 35 15.4 Minimally satisfied 8 3.5 Not satisfied at all 3 1.3 If you had the choice, would you undergo the procedure again under the same conditions? No 14 6.1 Yes 214 93.9 Did the surgery increase your functional capacity? No 31 13.6 Yes 197 86.4 Did the surgery relieve your pain? No 12 5.3 Yes 216 94.7 Would you recommend this surgery to your friends or relatives? No 26 11.4 Yes 202 88.6   As shown in Figure 2, Most members of the surveyed population express positive views about their health according to the data shown in the figure. The "Excellent" health rating was received by 80 subjects made up 39% of the total respondents while "Very Good" was earned by 81 individuals which amounted to 39.5% of participants. The substantial numbers grap a real picture of how well this demographic feels about their health. The respondents categorizing their health as "Good" made up 22% of the study participants indicating a possible opportunity to improve their health condition. The assessment of "Fair" health status and "Poor" health status was reported by 8% of participants at 16 people and 3% with six individuals respectively.       Figure 2: Illustrates Health Status Among Participants   The data in Table 3 demonstrates valuable findings about patient life quality after total knee replacement treatments which examined 228 surgical patients. A substantial number of respondents described their health conditions positively because 70.6% rated their health "Excellent" or "Very Good." The outcome demonstrates surgical success since the procedure effectively produces improved total patient welfare. Most patients (72.8%) experienced no limitations in doing moderate activities while 57.5% showed no restrictions in climbing staircases multiple times illustrating the successful role of surgical intervention in restoring functional mobility. Some patients faced limitations to their daily activities because of emotional problems although this only occurred in a significant minority according to survey results (13.6%). The research indicates that 55.7% of participants faced no daily task challenges due to pain but ongoing pain management solutions might benefit the few people who faced any level of interference.   Table 3: Participants’ Quality of Life After Total Knee Surgery Replacement (N=228) Parameters No. Percent (%) In general, would you say your health is Excellent 80 35.1 Very Good 81 35.5 Good 45 19.7 Fair 16 7.0 Poor 6 2.6 Does your health now limit you in moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf? Yes, Limited A Lot 17 7.5 Yes, Limited A Little 45 19.7 No, Not Limited At All 166 72.8 Does your health now limit you from climbing several flights of stairs? Yes, Limited A Lot 21 9.2 Yes, Limited A Little 76 33.3 No, Not Limited At All 131 57.5 During the past 4 weeks have you had any of the following problems with your work or other regular activities as a result of your physical health and accomplished less than you would like? No 163 71.5 Yes 65 28.5 During the past 4 weeks have you had any of the following problems with your work or other regular activities as a result of your physical health and were limited in the kind of work or other activities? No 165 72.4 Yes 63 27.6 During the PAST 4 WEEKS, were you limited in the kind of work you do or other regular activities as a result of any emotional problems (such as feeling depressed or anxious) and accomplished less than you would like? No 197 86.4 Yes 31 13.6 During the PAST 4 WEEKS, were you limited in the kind of work you do or other regular activities as a result of any emotional problems (such as feeling depressed or anxious) and didn’t do work or other activities as carefully as usual No 197 86.4 Yes 31 13.6 During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? Not At All 127 55.7 A Little Bit 53 23.2 Moderately 35 15.4 Quite A Bit 9 3.9 Extremely 4 1.8 Have you felt calm and peaceful? Yes, All the Time 96 42.1 Yes, Most of the Time 13 5.7 Yes, A Good Bit of the Time 88 38.6 Yes, Some of the Time 14 6.1 Yes, A Little of the Time 11 4.8 No, None of the Time 6 2.6 Did you have a lot of energy? Yes, All the Time 57 25.0 Yes, Most of the Time 107 46.9 Yes, A Good Bit of the Time 16 7.0 Yes, Some of the Time 34 14.9 Yes, A Little of the Time 7 3.1 No, None of the Time 7 3.1 Have you felt downhearted and blue? Yes, All the Time 3 1.3 Yes, Most of the Time 3 1.3 Yes, Some of the Time 26 11.4 Yes, A Little of the Time 18 7.9 No, None of the Time 178 78.1 During the past 4 weeks, how much of the time have your physical health of emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? Most of the Time 7 3.1 A Good Bit of the Time 3 1.3 Some of the Time 17 7.5 A Little of the Time 35 15.4 None of the Time 166 72.8   Table 4 within the research article shows findings about total knee replacement surgery patient satisfaction which provides essential understanding of postoperative experience for studied subjects. The surgical intervention demonstrated effectiveness through patient satisfaction results because 84.2% of participants expressed high satisfaction rates. A minority set of patients made up 7.9% of those who described their satisfaction as moderate while an exact same percentage rated it as low.   Table 4: Shows Satisfaction with Total Knee Replacement Surgery Score Results Parameters Frequency Percent Patients are highly satisfied 192 84.2 Patients are moderately satisfied 18 7.9 Patient is not satisfied 18 7.9 Total 228 100.0   The research article uses Table 5 to deliver powerful findings about patient perception of treatment success and quality of life following total knee replacement operations. The majority of 79.4% of study participants expressed high levels of satisfaction alongside Quality of Life improvements after their total knee replacement surgery. Total knee replacement surgery proves effective as a treatment approach because it improves the life quality of people who suffer from painful knee disorders. The evaluation reveals that 17.1% of patients achieved moderate satisfaction along with QoL improvement after their knee replacement surgery. The 3.5% of patients with low satisfaction indicate potential postoperative complications or unfulfilled expectations and results.   Table 5: Shows Satisfaction and Qol Regarding Total Knee Replacement Surgery Score Results. Parameters Frequency Percent High satisfaction and QoL 181 79.4 Moderate satisfaction and QoL 39 17.1 Low satisfaction and QoL 8 3.5 Total 228 100.0   Table 6 shows that satisfaction with knee replacement surgery has statistically significant relation to residential region (P value=0.008), educational level (P value=0.025), marital status (P value=0.008), surgery date (P value=0.0001), height (P value=0.003), and weight (P value=0.001). It also shows statistically insignificant relation to gender, age, and type of operation. Participants of western region, holding a bachelor’s degree, married, 170 to 175 cm in height, and weighing 85 to 90 kg were found to have higher satisfaction levels than others.   Table 6: Relation Between Satisfaction with Knee Replacement Surgery and Sociodemographic Characteristics. Parameters Satisfaction with knee replacement surgery Total (N=228) p-value* Patient is highly satisfied Moderate or no satisfaction Gender Female 113 22 135 0.800 58.9% 61.1% 59.2% Male 79 14 93 41.1% 38.9% 40.8% Age 54 years or less 55 12 67 0.140 28.6% 33.3% 29.4% 55 to 59 59 7 66 30.7% 19.4% 28.9% 60 to 65 41 13 54 21.4% 36.1% 23.7% 66 or more 37 4 41 19.3% 11.1% 18.0% Residential region Northern region 30 14 44 0.008 15.6% 38.9% 19.3% Southern region 8 2 10 4.2% 5.6% 4.4% Central region 75 14 89 39.1% 38.9% 39.0% Eastern region 10 0 10 5.2% 0.0% 4.4% Western region 69 6 75 35.9% 16.7% 32.9% Educational level Primary school 17 0 17 0.025 8.9% 0.0% 7.5% Middle school 29 4 33 15.1% 11.1% 14.5% High school 51 18 69 26.6% 50.0% 30.3% Bachelor’s degree 73 7 80 38.0% 19.4% 35.1% Master’s degree 11 4 15 5.7% 11.1% 6.6% PhD 2 0 2 1.0% 0.0% 0.9% Uneducated 9 3 12 4.7% 8.3% 5.3% Marital status Single 1 0 1 0.008 0.5% 0.0% 0.4% Married 134 19 153 69.8% 52.8% 67.1% Divorced 14 5 19 7.3% 13.9% 8.3% Widowed 26 2 28 13.5% 5.6% 12.3% Separated 17 10 27 8.9% 27.8% 11.8% Type of operation One knee joint replacement 168 31 199 0.818 87.5% 86.1% 87.3% Both knee joint replacement 24 5 29 12.5% 13.9% 12.7% Surgery date <1 year and more than 3 months 59 5 64 0.0001 30.7% 13.9% 28.1% 1 year 77 10 87 40.1% 27.8% 38.2% 2 years 40 11 51 20.8% 30.6% 22.4% 3 years 13 1 14 6.8% 2.8% 6.1% More than 3 years 3 9 12 1.6% 25.0% 5.3% Height 160 or less 64 18 82 0.003 33.3% 50.0% 36.0% 161 to 169 46 6 52 24.0% 16.7% 22.8% 170 to 175 51 1 52 26.6% 2.8% 22.8% 176 or more 31 11 42 16.1% 30.6% 18.4% Weight 84 kg or less 61 9 70 0.001 31.8% 25.0% 30.7% 85 to 90 81 7 88 42.2% 19.4% 38.6% 91 kg or more 50 20 70 26.0% 55.6% 30.7% *p value was considered significant if ≤ 0.05.   Table 7 shows satisfaction and QoL with knee replacement surgery has statistically significant relation to gender (p value = 0.002), residential region (p value = 0.0001), marital status (p value = 0.012), surgery date (p value = 0.0001), and weight (p value = 0.0001). It also shows statistically insignificant relation to age, educational level, type of operation, and height. Participants who are of male gender, residing in western region, married, and weighing 84 kg or less were found to have higher satisfaction and quality of life than others.   Table 7: Satisfaction and Qol with Knee Replacement Surgery in Association with Sociodemographic Characteristics Parameters Satisfaction and QoL with knee replacement surgery Total (N=228) p-value* High satisfaction and QoL Moderate or low satisfaction and QoL Gender Female 98 37 135 0.002 54.1% 78.7% 59.2% Male 83 10 93 45.9% 21.3% 40.8% Age 54 years or less 48 19 67 0.198 26.5% 40.4% 29.4% 55 to 59 54 12 66 29.8% 25.5% 28.9% 60 to 65 47 7 54 26.0% 14.9% 23.7% 66 or more 32 9 41 17.7% 19.1% 18.0% Residential region Northern region 22 22 44 0.0001 12.2% 46.8% 19.3% Southern region 10 0 10 5.5% 0.0% 4.4% Central region 68 21 89 37.6% 44.7% 39.0% Eastern region 10 0 10 5.5% 0.0% 4.4% Western region 71 4 75 39.2% 8.5% 32.9% Educational level Primary school 12 5 17 0.119 6.6% 10.6% 7.5% Middle school 26 7 33 14.4% 14.9% 14.5% High school 51 18 69 28.2% 38.3% 30.3% Bachelor’s degree 71 9 80 39.2% 19.1% 35.1% Master’s degree 12 3 15 6.6% 6.4% 6.6% PhD 2 0 2 1.1% 0.0% 0.9% Uneducated 7 5 12 3.9% 10.6% 5.3% Marital status Single 0 1 1 0.012 0.0% 2.1% 0.4% Married 130 23 153 71.8% 48.9% 67.1% Divorced 12 7 19 6.6% 14.9% 8.3% Widowed 21 7 28 11.6% 14.9% 12.3% Separated 18 9 27 9.9% 19.1% 11.8% Type of operation One knee joint replacement 156 43 199 0.331 86.2% 91.5% 87.3% Both knee joint replacement 25 4 29 13.8% 8.5% 12.7% Surgery date <1 year and more than 3 months 55 9 64 0.0001 30.4% 19.1% 28.1% 1 year 78 9 87 43.1% 19.1% 38.2% 2 years 34 17 51 18.8% 36.2% 22.4% 3 years 10 4 14 5.5% 8.5% 6.1% More than 3 years 4 8 12 2.2% 17.0% 5.3% Height 160 or less 62 20 82 0.184 34.3% 42.6% 36.0% 161 to 169 45 7 52 24.9% 14.9% 22.8% 170 to 175 44 8 52 24.3% 17.0% 22.8% 176 or more 30 12 42 16.6% 25.5% 18.4% Weight 84 kg or less 65 5 70 0.0001 35.9% 10.6% 30.7% 85 to 90 74 14 88 40.9% 29.8% 38.6% 91 kg or more 42 28 70 23.2% 59.6% 30.7% *P value was considered significant if ≤ 0.05.

Health professionals consider Total knee arthroplasty (TKA) as an essential treatment method for severe knee osteoarthritis patients while their satisfaction levels with this surgical approach continue to receive substantial interest. The present study conducted as a cross-sectional survey aimed to measure TKA outcome satisfaction among Saudi Arabian patients. The majority of 79.8% of survey participants expressed elevated satisfaction levels following surgery which demonstrates the successful ability of TKA to enhance patient quality of life (QoL). Several previous studies verify these findings since most knee replacement surgery patients detect meaningful functional and pain improvement outcomes after their procedures. The results of systematic reviews indicate patients achieve measurable quality of life enhancements following total knee arthroplasty because their satisfaction numbers surpass 70% [13]. The positive satisfaction responses could be attributed to medical progress that has resulted in better surgical methods and post-treatment care which decreases adverse effects and hastens recovery [14].   Patient satisfaction after TKA proves to be highly impacted by various demographic characteristics of the individuals undergoing treatment. Our study along with other research establishes that residents living in the western area combined with individuals holding higher education degrees and those who are married tend to have better post-TKA satisfaction results. Health literacy increases following education according to previous research which studied patients undergoing comparable procedures [15] fSuccessfully improving patient compliance with surgeries recovery protocols. Postoperative patients benefit from social support networks since their marital status affects recovery by enhancing emotional stability while teaching adaptive coping methods [16]. The findings of our study support research from Tabassum et al. by demonstrating the importance of social and cultural conditions on patient recovery experiences after total knee arthroplasty [17].   The analysis demonstrates that significant associations exist between patient productivity improvements and satisfaction levels following medical procedures. Although most patients were satisfied with their post-operative experiences our research showed that 17.1% reported moderate satisfaction scores because their pain persisted beyond expectations. According to research high pain ratings three months after the procedure result in lasting dissatisfaction together with decreased functional outcomes [18]. The data shows that TKA achieves excellent outcomes for numerous patients but certain patients will need supplemental measures to achieve lasting satisfaction.   The discussion about functional improvements gained following surgery deserves specific attention for a proper assessment. Research supports our findings which show that 86.4% of patients experienced better physical capabilities after surgery for TKA since effective rehabilitation following TKA operations leads to improved mobility and functionality [19]. Joint stability along with long-term muscle strength may reach their potential peak through comprehensive rehabilitation programs which ensure optimal satisfaction levels according to research [14]. The recovery framework is multifactorial according to research [20] which shows that certain patients encounter ongoing limitations from psychological aspects and sustained pain. Such strong relationships between knee function and mental recovery episodes suggest that TKA patients need integrated treatment methods including mental health support.   The findings of this present work need attention regarding their capacity to generalize. Based on its nature as a geographic-area specific research this study restricts generalizable results to broader population groups. The research approach implemented diverse sampling but probably failed to properly include every demographic element which effects patient satisfaction. Studies have identified that surgical methods together with patient demographics and healthcare setup differences produce major impacts on TKA surgical outcomes as well as patient attitudes [21]. The small sample size of participants from selected demographics reduces the strength of the research findings thus new research should include participants from diverse backgrounds to improve widespread understanding of satisfaction factors.

Our research confirms patients in Saudi Arabia achieve significant satisfaction from their total knee replacement experiences according to established TKA effectiveness studies. The research demonstrates how individual patient contexts must guide personalized care strategies because demographic factors affect satisfaction outcomes. Advanced holistic care practices for TKA surgery require detailed monitoring of patients who encounter complications or unmet clinical expectations because of their dissatisfaction. Research advancements must focus on combining extensive patient experience evaluations with long-term monitoring because this combination will help enhance surgical post-operation care systems for various patient needs.   Acknowledgement We acknowledge all of the volunteers who provided samples for this research.   Ethical approval After fully explaining the study and emphasizing that participation is optional, each participant gave their informed consent. The information gathered was safely stored and utilized exclusively for study.   Funding This study was not supported by any outside sources.   Conflict of interests The authors declare no conflict of interest.   Informed consent Written informed consent was acquired from each individual study participant.   Data and materials availability All data associated with this study are present in the paper.