Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological, and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done. Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making relevant to TKA in knee OA in Saudi Arabia and elsewhere.