Total knee replacement (TKR) is an increasingly common surgery among individuals with osteoarthritis (OA). Although the outcomes of this surgery are generally deemed positive, many are not fully satisfied with their return to pre-TKR occupations. The literature on pre-TKR occupational engagement is limited and primarily describes how the symptoms associated with OA restrict participation in occupation with little attention given to the significance occupations hold for individuals waiting for a TKR. A secondary analysis of eight purposively extracted transcripts from a primary study examining why people with OA do or do not re-engage in pre-operative occupations following hip or knee replacement was conducted. A qualitative thematic analysis approach was used to examine the pre-TKR experiences of these individuals from an occupational perspective. Three themes were identified: (1) living with OA: it is more than just the knee, (2) gradually losing my occupational identity, and (3) losing too much—a “tipping point.” The findings suggest that the significance of lost occupations is key and unique to each individual and affects their decision for surgery.