Summary In summary, we feel that the total replacement knee joint prosthesis deserves a permanent place in the armamentarium of the reconstructive surgeon. Instability due to combined femoral and tibial articular destruction is the indication for the procedure. A predictable result may be anticipated so long as the patient has the required anatomic assets. A proposed change in surgical technique should increase the yield of successful operations. Failure can be retrieved by means of athrodesis. Total replacement of the knee joint utilizing a prosthesis is not a procedure to be utilized instead of joint debridement, femoral prosthetic replacement, or tibial prosthetic replacement. Its place is in reconstruction of the knee whose articular integrity is so compromised that partial replacement cannot solve the problem. The only alternative procedure is therefore arthrodesis.