Current demographic trends with an increasing number of older patients, have led to a rising number of patients with higher demands on performance. Osteoarthritis in younger patients caused by abnormal forms or accidents also pose new challenges for medical professionals in the orthopedic field. As a rule of thumb, all conservative therapeutic possibilities should be exhausted before starting a surgical intervention. The main aims of surgery are to reduce pain, increase mobility and quality of life. In order to qualify for total knee arthroplasty (TKA) patients must fulfil major and minor criteria; however, after TKA approximately one fifth of patients are not satisfied with the result. In order to reduce this rate, indications should be narrowly set and expectations should be thoroughly discussed with the patient prior to an intervention. The high degree of dissatisfaction must be improved by intensifying efforts in further research.