**1. History and introduction**

The very first concept of improving knee function was introduced by Verneuil in 1860. He proposed an interposition of soft tissues in order to reconstruct articular surface. Unfortunately, it has led to disappointing results. In the same year, Ferguson resected the entire surface of the knee, which culminated with a better range of motion but lacked stability. In 1958, MacIntosh described a hemiarthroplasty using an acrylic tibial plateau later upgraded by McKeever for a prosthesis made of metal, showing better results.

Guston developed a polycentric prosthesis wich arculates metal to a polyethylene base fixed to the bone by acrylic cement, but the actual concepts used in total knee arthroplasty (TKA) have been established by Freeman in 1973: minimal bone resection; minimal chance of loosening;

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minimal debris production; not leaving dead spaces; avoiding long intramedullary stem and intramedullary cement; a standard insertion procedure; minimal range of motion (5–90°); resisting rotation; and resisting excessive movements in any direction.

During the early 1970s, a range of prostheses such as unicondylar, bicondylar, and hinged were used with respect to the patient's preoperative condition and deformity. Since then, a lot of different kinds of implants have been developed following the tendency of maximizing flexion, minimizing wear, and better accommodation of gender and racial anatomic variation. Nowadays, a resurrection of old strategies such as uncemented fixation and partial knee replacement has been noted and minimally invasive approaches are growing respecting the patient's desire of shortening postoperative recovery [1, 2].

This chapter introduces a TKA preoperative planning method based on mechanical alignment and the modified GAP balancing principles. Kinematic alignment (KA) principle, anterolateral approach, and strategies for soft tissue balancing in special situations are cited as well.
