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 of others. Modern knee arthroplasty began in the 1970s. The principles announced in 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. Currently, human diseases can be broadly summarized into four categories: namely, trauma, infections, genetic diseases (including cancer), and civilizational diseases (e.g., obesity, cardiovascular disease, etc.). They all attack the skeletal-articular-muscular system, and sometimes a combination of two or three types of diseases causes arthropathies. The American College of Rheumatology classifies joint diseases into ten major groups of more than 200, the first three of which are mostly arthritic. The first category is widespread connective tissue disease, such as rheumatoid arthritis; the second category is arthritis associated with the spine, such as ankylosing spondylitis and psoriatic arthritis; and the third category is osteoarthritis. These are fairly common joint diseases in orthopedic clinics. In a preliminary survey in China, the incidence of rheumatoid arthritis is 0.3% and osteoarthritis is 3%. In 1992, 300,000 artificial joint replacements were made in the United States for patients with osteoarthritis. Similar statistics are not available in China, but if the population ratio is 5:1, there could be 1 million to 1.5 million osteoarthritis patients in China who need artificial joint surgery. Today, total knee arthroplasty has become a common clinical procedure with a clinical excellence rate of more than 90% over 10 years. Each year, a large number of patients undergo total knee arthroplasty, and it is estimated that in the United States and Europe alone, there are currently approximately 200,000 to 300,000 knee replacements performed annually. Total knee arthroplasty is used for severe joint pain, instability, deformity, and severe impairment of activities of daily living, where conservative treatment has been ineffective or ineffective. These include: various inflammatory arthritis of the knee, such as rheumatoid arthritis, osteoarthritis, hemophilic arthritis, Charcot arthritis, etc.; a few traumatic arthritis, osteoarthritis after failed high tibial osteotomy; patellofemoral arthritis in a few elderly people; resting infectious arthritis (including tuberculosis), a few primary or secondary osteochondro-necrotic diseases. It must be emphasized that total artificial knee arthroplasty is not a perfect surgical procedure, and although the majority of patients have satisfactory outcomes, attention must be paid to the selection of indications, otherwise the outcome will certainly be compromised, and cases with other surgical indications should avoid total artificial knee arthroplasty whenever 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 of advanced age. 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 in cases where the muscles around the knee are paralyzed, the knee has been fused in a functional position for a long time, and there are no 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, patients who are mentally abnormal and do not understand 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.