Dr. Kastenbaum, whom I studied under, is now supposed to be a master of joint replacement surgery in the United States. In recent years, he has been recognized as one of the best doctors in the United States and New York for many years. He has been engaged in joint replacement surgery for more than 20 years, and China’s joint replacement surgery, especially total knee replacement surgery, began to fully develop around 2000, in which many of the big-name doctors, including those from Beijing, Shanghai, Guangzhou, Fujian, etc., who are now doing joint surgeries in China, came to him for learning or exchanges. After attending Dr. Kastenbaum’s surgery, I had a lot of insights and gained a lot. There are two points that stand out. One is that when he does knee replacement surgery, whether it is initial replacement surgery or revision surgery, he does it step by step and the details are very well done. From the preoperative patient position, disinfection, laying sterile sheet, all carefully prepared. The incision is routinely marked with a preoperative marker pen, the incision, exposure, osteotomy, measurement of the joint flexion and extension gaps, to the final installation of the prosthesis, each surgical step is completely standardized, details can not be omitted. Even though very familiar with each step, he was meticulous with each patient. The main feature is that the lateral patella is loosened to different degrees, the tibia is positioned intramedullary, the tibia is cut first and then the femur is cut, the femur is cut using a combination of anterior and posterior positioning, the femur is cut anteriorly, so as to avoid notch in the front of the femur, the prosthesis is more loosely fitted, and the choice of prosthesis is rather small than large. Another feature is that no tourniquet is used during the operation. The premise is to keep the anesthesiologist’s blood pressure low during the operation, so that there is not much bleeding during the operation, and there is no problem when the prosthesis is installed. The advantage is that it facilitates arthroplasty in patients who themselves have diabetes, atherosclerosis and other vascular diseases that do not allow or are cautious about using tourniquets, and reduces postoperative complications.