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Despite the overall success and widespread utilization of total knee arthroplasty (TKA), studies on inpatient TKA show that an average of 10% of patients are unsatisfied with their outcomes. Patient satisfaction with modern outpatient TKA care pathways in the ambulatory surgery center (ASC) is not well studied. We therefore asked the following questions: (1) What is the prevalence of patient satisfaction and dissatisfaction following outpatient TKA in an ASC? (2) How do preoperative and postoperative patient-reported outcome measures, pain scores, and preparedness for surgery compare between satisfied and nonsatisfied patients? (3) Do radiographic factors such as Kellgren-Lawrence grade, posterior tibial slope, tibiofemoral angle, or postoperative flexion of the femoral component differ between satisfied and nonsatisfied patients? We retrospectively reviewed 678 patients undergoing primary unilateral TKA from 2022 to 2023 at a single ASC. Demographics, baseline function, surgical variables, complications, patient-reported outcomes, and patient satisfaction were recorded. Analysis of the difference between the satisfied and nonsatisfied groups was performed. Based on our criteria, 92.5% (<i>n</i> = 627) of patients were either "satisfied" or "very satisfied," whereas 7.5% (<i>n</i> = 51) of patients were "neutral," "dissatisfied," or "very dissatisfied." Body mass index, age, sex, and preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement were not associated with postoperative dissatisfaction. Low Veterans Rand 12-Item Health Survey Mental Component Summary (VR-12 MCS), and lower preoperative "preparedness for surgery" scores were associated with nonsatisfaction. Patient satisfaction following TKA in an ASC was 92.5% in our cohort. Pain relief, functional improvement, patient expectations, and psychosocial factors were associated with satisfaction. Addressing these factors with perioperative care pathways that include enhanced pain management, personalized patient education, and attention to psychosocial and cultural factors may further improve satisfaction rates.