A descriptive qualitative study of lived experiences, coping, and treatment decisions among older adults undergoing total knee replacement

Background Knee osteoarthritis (KOA) is a progressive condition that compromises independence, mobility, and emotional well-being. Total knee replacement (TKR) is increasingly recognized as the primary surgical option for pain relief and functional restoration in individuals with severe KOA. While decisions to undergo TKR are shaped by biological, psychological, and social considerations, the psychosocial dimensions, particularly patient perspectives, cultural values, and family involvement in decision-making, remain underexplored in Malaysia. In this study, we aimed to examine the preoperative and early postoperative experiences of older adults to better understand the factors influencing their decision-making regarding TKR. Methods A qualitative descriptive design using purposive sampling was employed. Data were collected through individual semi-structured in-depth interviews and analysed thematically. Study conduct and reporting followed the COREQ guidelines to ensure rigour and trustworthiness. Results Eleven participants (median age 70 years, range 62–85 years) shared their experiences of the surgical journey. Thematic analysis identified three overarching themes: (1) the pervasive impact of knee pain, which explored how chronic symptoms compromise independence, mobility, and emotional well-being; (2) psychosocial influences on decision-making, which characterizes the internal heuristic processes and risk-benefit appraisals governing surgical intent; and (3) social identity and cultural norms shaping surgical choices, highlighting how relational dynamics, cultural paradigms, and family-centric values orchestrate the transition from candidacy to consent. Collectively, these findings illustrate a complex interplay between biological, psychological, and social considerations, suggesting that the choice to undergo TKR is a reflective process rather than an impulsive one. Collectively, these findings suggest that TKR uptake is not a discrete medical event but a longitudinal, deliberative process, an "intentional odyssey" shaped by the intersection of physiological necessity and cultural identity. Conclusion Older adults’ decisions to proceed with TKR are not impulsive, but rather reflect a process of cumulative suffering, layered support, and careful reflection. Recognizing the nuanced role of psychosocial influences is critical. A patient-centred, culturally sensitive approach that addresses both the biological and psychosocial dimensions of TKR decision-making is essential to support this population’s unique needs.