Incidence of hip and knee osteoarthritis is increasing in India. Increasing longevity, urban lifestyle combined with obesity are the main causes of knee arthritis. Hence, the need of patients requiring joint replacement surgery is also on a steep rise. Rheumatoid arthritis requiring joint replacement surgery also remains as a cause though the incidence has gone down significantly in the last 2 decades due to better DMARDs and biological agents. Treatment options in early knee Osteoarthritis: Early knee arthritis can be very well managed conservatively by NSAIDS, rest, activity modification and Physiotherapy. Nutritive supplement for cartilage and intra articular injections of hyaluronic acid/ steroid/ PRP can also be used in some cases. Treatment options for advanced knee Arthritis:Patients with advanced knee arthritis have very limited walking, altered gait pattern (slow and waddling gait), analgesic dependence and difficulty in using stairs. There is deformity in both planes i.e varus/valgus combined at times with varying degrees of flexion deformity or hyperextension. The limited mobility has a huge impact on patients’ social and recreational lives, making them functionally crippled. This can also lead to social isolation and clinical depression. These patients deserve joint replacement surgery to make them functionally better again and relieve their pain. Goals of a Total Knee Replacement surgery: The goal of surgery is pain relief and deformity correction. This is achieved by making the knee stable (balance the ligaments), correcting the deformity and achieving neutral alignment in both planes. The standard knee replacement surgery is a misnomer, it is actually a knee resurfacing surgery. The femoral and tibial surface is cleared off the osteophytes and worn out surfaces are cut with a precision saw. The jigs are used to get the desired alignment and the ligament balancing is done manually step by step releasing the concave side (medial in varus and lateral in valgus knee). Posterior knee is also cleared off osteophytes and synovium and posterior capsule released in flexion deformities through the same incision. Present day knee replacement surgery is more predictable due to the access of various sizing options in terms of in between sizes and inserts of least count of 1 mm helping the surgeon to achieve accurate ligament balance and alignment. In severe deformities and in cases where intra medullary instrumentation is contraindicated handheld robotic navigation devices are very helpful in getting the alignment of femoral and tibial components and helping to verify the cut. Third generation cementing techniques make the cementing of the knee femoral, tibial and patellar components safe and effective. Various prosthetic surface materials are available for the young arthritis knee patients. Oxidise zirconium (Oxynium) is a ceramised metal with better corrosion resistance and wettability. Another coating is TiNbN (Gold knee): It comprises a TiNbN coating with the least wear property, which is 40% lesser than regular CoCr, the hardest surface (8 times harder than CoCr), 2 times stronger than other implants of similar category and the most biocompatible non-allergic surface material so as to decrease long term prosthetic wear. The standard all poly TKR is also being used to reduce wear in patients who have good bone quality. Advanced post operative management: Pain management by blocks, epidural, skin patches, intra articular infiltration of a combination of drugs all have drastically reduced the post operative pain. Along with pain management immediate same day mobilization and ambulation allows the knee to start functioning and does not allow the adhesions to form. The patient is made to stand the same day. The average stay is 4-5 days for single knee replacement and 6-7 days for single staged bilateral surgery. The knee function continues to improve up to 2-3 months post operatively. There are no limitations hereafter on walking, climbing, travelling and other recreational activities.