Total knee arthroplasty (TKA) is one of the most common operations in orthopedic surgery worldwide but despite being mainly successful only 81 % of patients are satisfied with the final result. The following systematic review compared patient satisfaction and analyzed the causal connections and influencing factors after TKA between 1990-1999 and 2000-2012. From 1990 to 1999 a total of 81.2 % of patients were satisfied after TKA and in the period 2000-2012 patient satisfaction increased to 85 %. Influencing factors on postoperative satisfaction derived from the 25 publications included in the study were consistently body-mass index, patient expectations, pain, joint function and mental factors. A lack of satisfaction scores and different designs resulted in difficulties in comparing the studies and were subsequently limitations of this study.