This study examined the role of a sense of purpose in life (PIL) in recovery from knee replacement surgery in 64 surgery patients. Each of the surgery patients had been diagnosed with severe osteoarthritis of the knee. Regression analyses were conducted predicting changes in health 6 months after surgery. When considered alone, PIL was related to less anxiety, depression, negative affect, functional disability, stiffness, and more positive affect. When optimism, pessimism, and emotionality were controlled, PIL was still related to less negative affect, depression, and anxiety, and more positive affect. The results suggest that PIL may be an important positive personal characteristic and target for interventions.