Patient Experiences Following Total Knee Arthroplasty in Peshawar, Pakistan: A Qualitative Thematic Analysis

ABSTRACT OBJECTIVES This study aimed to explore the psychosocial, cultural, and economic factors that influence the decision to undergo TKA and the postoperative recovery process in a resource-limited context. METHODOLOGY A qualitative descriptive study was conducted using semi-structured interviews with 31 patients (16 females, 15 males; aged 48-82 years) recruited from public and private hospitals between January and May 2025. Data were analyzed using Braun and Clarke’s reflexive thematic analysis framework. Data saturation was achieved after 31 interviews. RESULTSFive overarching themes emerged: 1. preoperative suffering and fear, 2. hospital experience amid systemic constraints, 3. inequities in postoperative rehabilitation, 4. cultural and financial determinants, and 5. transformative outcomes post-surgery. Delayed surgical decision-making, reliance on traditional healing (55%), and significant financial burden (79% catastrophic expenditure) were prominent findings. CONCLUSION TKA in Peshawar involves a complex biopsychosocial journey, shaped by cultural norms, economic hardship, and limitations in the health system. Addressing disparities in rehabilitation access and financial protection is critical to optimizing outcomes.