This was a retrospective cohort analysis of 112 patients undergoing primary total knee arthroplasty, wherein baseline demographics, resource utilization, and outcomes were compared by insurance type: Medicaid, Medicare, or private. At the time of surgery, Medicaid patients were younger (P < .0001) and had lower preoperative Knee Society Scores than Medicare and private patients (P = .0125). Medicaid postoperative scores were lower than those of private patients (P = .0223). The magnitude of benefit received by Medicaid patients was similar to Medicare and private patients. Medicaid patients had a higher number of cancelled (P = .01) and missed (P = .0022) appointments relative to Medicare and private patients. Medicaid patients also had shorter average follow-up periods compared to private patients (P = .0003). Access to care and socioeconomic factors may be responsible for these findings.