The development of total knee arthroplasty started in the fifth decade last century. Modern total knee joint systems represent a high grade of modularity for a usage within the whole range of joint destruction situations, such as for rheumatoid arthritis. Innovations for improved long term survival can be seen in methods reducing aseptic loosening, such as new implant materials or mobile platforms. Moreover improved surgical techniques for precise component orientation and reconstruction of a neutral leg axis have been introduced using computer assisted surgery. So far the results using this technique are very promising. Long term results are not yet available.