Purpose <p>This study aimed to evaluate the impact of two versus five postoperative X-ray protocols on patient perception following total knee arthroplasty (TKA), specifically assessing functional outcomes, quality of life, patient satisfaction and complication detection.</p> Methods <p>In this prospective randomized study, 206 patients who underwent TKA were assigned to one of two postoperative radiograph protocols. Group 1 (<i>n</i> = 102) received five X-rays at predefined intervals (immediately postoperative, 1 month, 3 months, 6 months, and 1 year), while Group 2 (<i>n</i> = 104) received only two X-rays (immediately postoperative and at 1 year). Functional outcomes were evaluated using the Knee Society Score (KSS) and Short Form-12 (SF-12). Satisfaction and complications were recorded over a 1-year follow-up period.</p> Results <p>At the 1-year follow-up, KSS-Function scores were comparable between groups (76.07 vs. 74.32, <i>p</i>-value = 0.234), while KSS-Knee scores were slightly higher in Group 2 (85.44 vs. 89.3, <i>p</i>-value = 0.003). Regarding quality of life, SF-12 physical scores were similar (44.01 vs. 43.64, <i>p</i>-value = 0.628), whereas SF-12 mental scores were higher in Group 2 (56.72 vs. 58.57, <i>p</i>-value = 0.048). Mean satisfaction scores were comparable between groups (7.49 vs. 7.99, <i>p</i> = 0.08). No significant differences in complication rates were observed between groups (5 vs. 2, <i>p</i>-value = 0.458).</p> Conclusion <p>Increasing the number of postoperative X-rays after TKA did not improve patient satisfaction or perception of recovery. Patients who received only two X-rays reported similar or slightly better functional outcomes, mental well-being, and satisfaction levels compared to those who received five. Additionally, no benefit was observed in complication detection. These findings suggest that a more limited radiographic follow-up may be sufficient, reducing costs and radiation exposure without compromising patient confidence or clinical outcomes.</p>