The primary indication for total knee replacement is pain and dysfunction due to degenerative or inflammatory arthritis. The artificial knee consists of a resilient, highly polished metal alloy which is designed to cap the femur and articulate with a high-density cross-linked polyethylene tibial component. The polyethylene is often held in place on top of the tibia with a metal tray. Resurfacing the patella with a rounded piece of polyethylene is commonly performed. Most total knee devices use bone cement for fixation; however, some designs have porous metal surfaces which allow for bony ingrowth.

The procedure is commonly performed through a midline skin incision over the anterior aspect of the knee. An incision is then made along the medial border of the patella and the patella is everted laterally, providing full exposure of the ends of the tibia and femur so that they can be prepared by making several cuts using special guides. Careful attention is given to the alignment of the components and the balancing of the knee ligaments. The operation usually takes less than 2 hours, though complicated total knee replacements can take longer. General, spinal, and epidural anesthesia are routinely used. The surgery is usually performed with a tourniquet on the upper thigh to limit intraoperative blood loss. Postoperative bleeding will occasionally require a transfusion, though this complication is more common in total hip arthroplasty. Based on the likelihood of the need for transfusion, which is usually low for primary total knee arthroplasty, autologous blood donation is recommended.