Total knee arthroplasty (TKA) has become the most effective treatment for advanced knee osteoarthritis. This approach has been proven to be reliable and long-lasting. A successful knee replacement allows almost all arthritic patients to continue their daily activities. In many cases, patients do not require prolonged external fixation or long-term medication. Ultimately, knee arthroplasty helps them regain function so that they can live independently without dependence on others. Modern knee arthroplasty began in the 1970s. The principles declared for the first 10 years were surgical instrumentation application and keeping the ligaments intact. During this period, bone cement (polymethylmethacrylate) was a successful method to obtain fixation of the prosthetic component. Since then, there have been improvements in both surgical technique and prosthesis design. Modern instrumentation allows for more precise osteotomies. With the development of additional fixation methods, expanded surgical options, and enhanced raw material characteristics, the lifespan of knee implants has theoretically increased. Modern knee replacement research has focused on maximizing motion and all functional conditions in the patient’s most perfect patellofemoral joint. Artificial total knee arthroplasty is mainly used in cases of severe joint pain, instability, deformity, and severe impairment of activities of daily living, where conservative treatment is ineffective or ineffective. These include: 1, various inflammatory arthritis of the knee joint, such as rheumatoid arthritis, osteoarthritis, hemophilic arthritis, Charcot arthritis, etc.; 2, a few traumatic arthritis; 3, osteoarthritis after failed high tibial osteotomy; 4, patellofemoral arthritis in a few elderly people; 5, resting infectious arthritis (including tuberculosis); 6, a few primary or secondary osteochondral necrotizing diseases. It must be emphasized that total knee arthroplasty is not a perfect surgical procedure, and although the majority of patients have satisfactory results, attention must be paid to the selection of indications, otherwise the outcome will definitely be affected, and cases with other surgical indications should avoid total knee arthroplasty as much as possible. Although there are more complications in the elderly, TKA is a more desirable treatment option for severe osteoarthritis of the knee in elderly patients. However, as with medullary arthroplasty, any active infection of the systemic and local joints should be considered an absolute contraindication to knee replacement. Total knee arthroplasty should also be contraindicated when: 1) the muscles around the knee are paralyzed; 2) the knee has been fused in a functional position for a long time without symptoms of pain or deformity. Relative contraindications include young age, high postoperative activity, obesity, and poor surgical tolerance, all of which need to be carefully considered prior to surgery. In addition, the patient’s cooperative attitude is also an important factor affecting the outcome. For example, the patient’s mental abnormality and lack of understanding of the artificial joint will seriously affect the surgical outcome. According to the authors’ clinical experience, severe flexion contracture deformity (greater than 60°), severe osteoporosis, joint instability, severe muscle weakness, fibrous or bony fusion are not absolute contraindications to surgery.