Computer navigation was first used in brain surgery, in orthopedics with pedicle screws, and in 1997 with computer-guided knee surface replacements. In a study conducted by the European ESSKA Association and the Swiss (SGO-SSO) Association in 2008, about 33.1% of surgeons used navigation in more than 50% of knee surface replacement procedures, and 25% of surgeons used navigation in more than 75% of TKA. However, it is still used in a minority of hospitals in China. Soft tissue balance and alignment of the lower extremity are two key factors in the success of knee replacement. Poor alignment can affect the survival of the implanted prosthesis and affect knee function. Studies have shown that navigation is superior for prosthesis installation and knee force line acquisition. In this paper, we use retrospective analysis to compare the cases of knee arthroplasty performed under BrainLab navigation and conventional surgery since 2010, and show that it has certain advantages over conventional surgery, and we are the first unit in the province to perform this technology. Advantages of knee navigation surgery (1) The registered knee joint activity can be used to understand the actual patient’s preoperative joint functional status and to accurately quantify it, including internal and external rotation and flexion-extension mobility, and to compare it with the stress state, so that the degree of bony deformity of the knee joint and soft tissue tightness can be assessed, providing data to guide the standard knee joint replacement and further improving the theoretical and clinical knee joint level. (2) Through the three-dimensional spatial analysis of the computer navigation system, a matching knee prosthesis can be selected according to the individual characteristics of the three-dimensional structure of the knee joint. Timely feedback of information about the position and direction of the bone, implanted prosthesis and surgical instruments allows timely adjustment of surgical operations. (3) Guidance advantage of osteotomy: In standard knee surface replacement surgery, the osteotomy of the distal femur takes intramedullary positioning. In cases such as abnormal femoral stem development, abnormal healing of femoral stem fracture, post-femoral stem internal fixation, and post hip replacement disease, the intramedullary positioning rod cannot be inserted to sufficient depth, often based on the operator’s empirical judgment, which is the best indication for navigation surgery. (4) Advantages in soft tissue balance: The flexion-extension gap can be datated after the osteotomy is completed, which is a positive guide for medial and lateral soft tissue balance. This is an excellent learning opportunity for soft tissue balancing to improve for operators with traditional surgical approaches. Unnecessary soft tissue release can be avoided. Intraoperatively, soft tissue release can be adjusted based on the medial and lateral gap data provided by the computer. This builds on multiple factors: including the resection of marginal bony flaps, which is a pre-work for soft tissue release, and this is a mandatory step to be completed during navigation surgery registration, which can reduce registration errors. (5) The femur is positioned extramedullary, reducing the bleeding and trauma caused by intramedullary positioning. Studies have shown that the rate of bleeding and transfusion is lower in navigated surgery than in conventional surgery. Limitations of navigation-assisted TKA: (1) Slightly longer operation time: the navigation group takes more time to operate than the control group and requires special training to become proficient. (2) The installation of tracker fixation pins increases the risk of fracture, and both femoral and tibial fractures have been reported in the literature. However, the incidence is extremely low. (3) The accuracy of navigation-assisted surgery is disturbed by the following factors: (i) loosening of the tracker fixation will likely result in the inability to perform navigation surgery successfully; (ii) registering femoral head center information when the pelvis is not fixed, or hip abnormalities will result in inaccurate information. ③When registering femur or tibia information, unclear registration points or the presence of abnormal bone defect will lead to information errors. Relationship between clinical outcomes and navigational surgery As with conventional surgery, the acquisition of good knee function is influenced by three factors: i) the preoperative patient status; ii) the success of the surgery, including appropriate force line recovery, proper soft tissue balance, and correct rotational alignment; and iii) postoperative rehabilitation instructions. The preoperative evaluation one and postoperative rehabilitation guidance were the same in our group of cases, and the results showed no significant difference in the efficacy of navigation surgery and conventional surgery. Suggesting the desirability of our knee navigation surgery, with the improvement of surgical techniques and further reduction of surgical time, it will be possible to reflect the superiority of navigation surgery for lower limb force lines and soft tissue release. It is possible that it will have a greater impact on the long-term survival of the prosthesis. Further observation is needed due to the lack of long-term follow-up data.