The Variable Axis Knee Prosthesis was designed to accommodate a wide range of problems in the knee and to minimize the complication of loosening. The results of the series, which now spans over seven years at this institution, have confirmed the effectiveness of the prosthesis in providing stability and firm fixation. Patellar alignment remains critical for optimum results. A wide variety of abnormalities, including failed prostheses, severe flexion contractures, arthrodesed knees, and severely osteoporotic bone, can be effectively managed utilizing this device. As with any other total knee prosthesis, the use of this prosthesis should be restricted to those knees with definite radiographic evidence of joint impairment in addition to significant symptoms. Relative contraindications include previous sepsis, neuropathic joint disease, and gross ligamentous incompetency. If these indications and limitations are adhered to, the results from knee replacement can be expected to equal or exceed those from total hip replacement over the long term.