OBJECTIVES: Delaying a total knee arthroplasty (TKA) carries an increased likelihood of poor rehabilitation outcomes. TKA candidates may choose to delay surgery for a variety of reasons including perceptions of pain and interference with activities due to pain. This study explores patients’ perspectives and factors related to the decision to delay a TKA procedure.  METHODS: Cross-sectional online survey conducted among U.S. patients with arthritis who were candidates for TKA. Survey questions related to pain severity and activity interference due to pain were taken from the Brief Pain Inventory (BPI); additional questions were related to pain management, the decision to delay TKA surgery and demographic information. Data was analyzed using descriptive statistics and logistic regression using SAS 9.3. RESULTS: There were 654 respondents; mean age 64±7 years; 65.5% female; 62% with household income ≥$50,000; 55.4% with bachelor or graduate degree. Logistic regression showed that interference with work and concerns for pain (pain in the first 3 days or pain in the first several weeks following surgery) were significant in predicting the decision to delay knee replacement surgery. A one unit increase in the interference with work scale is associated with a 21.9% increase in the odds of delaying TKA surgery (95% CI: 1.095-1.356). Patients concerned about experiencing pain (first several weeks following surgery) had significantly higher odds of delaying surgery (OR: 1.64, 95% CI: 0.881-3.06). 92% of survey respondents indicated they would seek surgeons who offered an effective non-opiate pain management option during the rehabilitation period. Gender, income level, and education level were not significant factors in the decision to delay TKA surgery.  CONCLUSIONS: In a relatively wealthy, well-educated US-based population, the decision to delay a TKA is significantly influenced by patient concerns about interference with work and experiencing pain following TKA. Non-opioid pain management is important in selecting a surgeon.