Total knee arthroplasty (TKA) has been shown to be a durable and predictable procedure in the treatment of knee arthritis as measured by survivorship analysis and long-term clinical studies. However, it has become increasing important to measure patient satisfaction and functional activity following TKA. Following TKA, the patient’s perspective of improvement and satisfaction is fundamental to assessing the outcome of the procedure. Patient reported outcome measurement (PROM) has become a basic tool to assess the ultimate success of surgery. While there are several outcome tools available, each measure patient outcome over multiple domains such as pain, function and satisfaction. While the majority of patients are satisfied with their outcome, there is a significant minority that are dissatisfied, and expectations are not met. It is important that with continued research and analysis we investigate the factors that contribute to patient dissatisfaction. While there may be numerous unanswered questions to be considered, the biggest influence on satisfaction is meeting patient expectations. While these may be unreasonable, clear communication prior to surgery helps align both the patient and surgeon.