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Background and Aims Mindfulness meditation —a well-known practice to psychology research— is based on sustained, non-judgmental attention to the present moment. Anxiety and depression are known to affect total knee arthroplasty (TKA) outcomes such as pain and mobility and may be mitigated by meditation. This pilot study investigated, among TKA patients, the feasibility of a perioperative mindfulness meditation intervention (MMI): a pre-recorded guided meditation.Methods This pilot randomized controlled trial (IRB# 2023–2131) randomized 15 to an MMI and 15 to a waitlist control group (received the mindfulness intervention after data collection had finished for their group) ( table 1). Overall, 14 surveys were administered at 5 distinct timepoints. Feasibility measures focused on response rates and survey answers on the day of surgery and 14 and 90 days (POD0, 14, 90).Results In the MMI group 73.3% (11/15) listened to the intervention before surgery; all 11 MMI patients indicated that the MMI intervention at least somewhat improved their emotional distress or physical pain, as indicated by MMI practice survey responses ( table 2). Only 20.0% (3/15) of MMI patients completed the MMI practice survey on POD14 and POD90.Abstract EP199 Table 1Baseline characteristicsAbstract EP199 Table 2MMI practice survey responses across timepoints, intervention groupConclusions Most MMI-randomized patients listened to the audio before surgery and provided positive feedback, however survey completion declined substantially postoperatively, raising concerns about feasibility after surgery. This decrease may reflect limitations in our data collection methods rather than limited feasibility of the intervention itself. Future efforts should focus on improving patient response rates and reducing survey attrition, perhaps through reducing survey burden while maintaining sufficient meaningful data capture.