Total knee replacement has reliably been shown to have a beneficial effect in knee osteoarthritis; however, around 17 % of patients are dissatisfied with the result. A commonly proposed mechanism driving the dissatisfaction rate is a discrepancy between expected and actual/perceived outcome. Our aim was to conduct a systematic review examining any association between pre-operative expectations and satisfaction. A comprehensive electronic search strategy was used to identify studies from MEDLINE, EMBASE, and the Cochrane Library from inception until May 2015. Data was extracted according to PRISMA guidelines and an online, published protocol. Four studies are included in this review. One study found an association between expectations and satisfaction. Different measures of expectation and satisfaction were used in all studies. To date, there is no consensus on how expectations or satisfaction should be measured, and a large number of studies that have the available information failed to conduct the relevant sub-group analysis. Further elucidation and consensus of how to measure expectations and satisfaction around joint replacement would aid this area of study greatly. On the basis of the current evidence it appears expectations have a small effect, if any, on satisfaction after knee replacement.