This study aimed to address the lack of a holistic understanding of the total knee arthroplasty (TKA) journey in China by systematically mapping patient experiences to identify interconnected needs, emotional transitions and critical pain points across the entire care continuum.

A longitudinal descriptive qualitative study using patient journey mapping methodology. Data from three sequential one-on-one semistructured interviews (preoperative, in-hospital postoperative and home rehabilitation phases) were chronologically coded into journey stages.

A tertiary hospital in Shanghai, China.

Twelve patients scheduled for elective TKA, aged 61–80 years (mean 70.25±5.86).

Five categories with 17 subcategories were identified: (1) declining quality of life drives the need for change, (2) trust compensates for information gaps in decision-making, (3) hospital adaptation challenges heighten anxiety, (4) strong support needs emerge post-surgery and (5) navigating complex home recovery needs with insecurity. The patient journey was mapped across four stages: intention to change, consultation and decision-making, hospitalisation and surgery and rehabilitation and recovery. Analysis revealed several cross-stage issues: (1) the influence of disease status and treatment decision quality on postoperative outcomes, (2) inadequate preadmission preparation hindering hospital adaptation and comorbidity management and (3) insufficient predischarge planning leading to negative post-hospital rehabilitation experiences.

Quality deficits in early-stage interactions can trigger a cascading effect on subsequent patient experience and clinical outcomes. During the two critical phases of selecting a healthcare provider and deciding on surgery, patients undergo a transition from ‘insufficient information support’ to ‘reliance on trust’. However, irrational decision-making and unrealistic expectations collectively form a potential risk for postoperative decisional regret and dissatisfaction. Underused preoperative preparation leads to difficulties during hospitalisation, while inadequate discharge support hinders home recovery. Identifying these cross-stage pain points highlights timely intervention opportunities. Future improvements can be achieved through process redesign and technology integration, such as intelligent decision aids and remote rehabilitation systems, to enhance overall patient experience and outcomes.