Background and purpose: Patient satisfaction after total hip and knee arthroplasty (THA, TKA) is influenced by multiple factors, including patient-reported pain and function. We aimed to examine whether functional abilities or pain during specific activities are associated more than other aspects with satisfaction 1 year after THA and TKA.

Methods: This cohort study included all primary elective THAs and TKAs performed between January 2012 and June 2022 at a tertiary care university hospital. Ordinal logistic regression models were used to assess associations between patient satisfaction and WOMAC Pain and Function summary scores and items, 1 year postoperatively.

Results: 1,772 THAs and 1,323 TKAs were included. Individually, all scores and items were associated with satisfaction. However, multivariable models revealed differences in the strength of association. Global pain score (odds ratio [OR] THA: 2.80, 95% confidence interval [CI] 2.40-3.29; TKA: 3.61, CI 2.96-4.44), pain while walking on the flat (OR THA: 1.79, CI 1.45-2.22; TKA: 1.74, CI 1.43-2.11), and pain going up or down stairs (OR THA: 1.64, CI 1.37-1.96; TKA: 1.68, CI 1.44-1.97) showed the strongest associations in both populations. Among THAs, activities walking on the flat (OR 1.41, CI 1.17-1.68), putting on socks (OR 1.29, CI 1.12-1.48), and ascending stairs (OR 1.26, CI 1.08-1.46) contributed most to satisfaction, whereas among TKAs, walking on the flat (OR 1.41, CI 1.18-1.69), rising from sitting (OR 1.32, CI 1.11-1.58), and getting in or out of a car (OR 1.31, CI 1.10-1.57) did.

Conclusion: After THA/TKA, patient satisfaction is associated with pain during basic daily tasks-especially walking and stair climbing. Key functional drivers differ by joint: socks and stairs matter for THA, rising from sitting and getting in/out of a car matter for TKA.