Background Difficulties in kneeling, one of the poorest scoring functional outcomes post total knee arthroplasty (TKA),have been attributed to a lack of patient education. This is the first study to investigate specific factors affecting a patient's perceived ability to kneel post TKA, following exposure to a preoperative kneeling education session. Materials and methods A cross-sectional study was conducted following TKA with patients who had been educated about kneeling prior to the operation. Patients completed kneeling questionnaires at 6 (n = 115) and 12 (n = 82) months post TKA. In addition to the 12-month kneeling questionnaire, patients also completed the Oxford knee score (OKS) survey. Results Seventy-two percent of patients perceived they could kneel at 12 months post TKA. Overall, pain and discomfort were the most common factors deterring patients from kneeling. Perceived kneeling ability was the poorest scored outcome on the OKS with patients reporting mild to moderate difficulty with this task. Kneeling scores were strongly correlated with overall knee function scores (R = 0.70), strongly correlated with pain scores (R = 0.45) and weakly correlated with knee stability scores (R = 0.29). When asked about other factors preventing kneeling other than pain or discomfort, 75 % had reasons unrelated to the knee or TKA. The most common reason was 'problems with the other knee' (n = 19). Conclusions Patients in this study were provided with education regarding their kneeling ability post TKA, yet still experienced limitations in perceived kneeling ability postoperatively. Contrary to previous research, our study suggests that factors other than patient education affect a patient's perceived kneeling ability post TKA.