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Most previous research has used quantitative patient-rated outcome measures to identify patients' perceptions related to metacarpophalangeal (MCP) arthroplasty. However, little is known about the lived experience of this procedure. The present study aimed to gain an in-depth understanding of patients' expectations and experiences, and the determinants of satisfaction related to MCP arthroplasty and postoperative rehabilitation.Semi-structured interviews were conducted with six participants from two London hospitals at four months to three years post-surgery. Interviews were transcribed verbatim and analysed using descriptive phenomenological analysis.Participants' reasons for surgery varied considerably and their expectations were informed by previous surgical experience and information from healthcare professionals. Diverse, and occasionally ambivalent, perceptions of various aspects of postoperative treatment were expressed and all participants emphasized the importance of reassurance and understanding by the healthcare team. When describing the effect of surgery on their lives, all experienced a period of ‘frustrating dependence’ and adopted a variety of psychological and practical coping mechanisms. Experience of recovery and long-term outcome was influenced by factors extraneous to MCP arthroplasty, including medical condition and disease at adjacent joints. Factors influencing satisfaction included participants' evaluation of the extent to which goals and preoperative expectations had been met and the impact of surgery on their lives.Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations. Education on all aspects of postoperative care is vital. Patients should be made aware of variability in outcome and the potential for deterioration due to the chronic nature of rheumatoid arthritis. Copyright © 2013 John Wiley & Sons, Ltd.