Although total knee arthroplasty (TKA) is considered to be a cost-effective intervention, most patients do not experience natural joints, and it is reported that up to 20% of them are dissatisfied [1, 2]. A systematic review of gait analysis after TKA indicates that patients display significant kinematic differences from normal controls [3]. Due to the significant deficiencies in both our knowledge and technology in the past, we were far from replicating normal knee kinematics with TKA. These limitations in TKA function and patient satisfaction should stimulate us to restart the entire development process. Enhancements in our understanding of knee anatomy and biomechanics may suggest ways of improving TKA outcomes. Implant design needs to be advanced to reproduce the anatomy and kinematics of native knees. More precise surgical techniques with navigation, patient-matched instrumentation and robotics need to be further refined. The future of TKA is to produce more natural knee joints, with resultant improved patient satisfaction and ultimately a forgotten joint.
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