Total knee arthroplasty [TKA] is a commonly performed surgical procedure designed to alleviate knee pain and improve function in individuals with knee osteoarthritis the purpose of collecting the latest information and updating the reports is to summarize the published articles and inform the colleagues. In so doing, the articles published in American journals of arthroplasty and joint surgery and the proceedings of the conferences that were mostly held in 2004 have been utilized so that delicate and precise spotlights retrieved from scholars' breakthroughs can be applied in daily medical practices. It should be noted that this surgery is as much effective as cardiovascular bypass surgery in enhancing the quality of the patients' lives. Pain is one of the major problem for patients underwent Total Knee Arthroplasty [TKA]; appropriate pain management is a key factor that can result early to move, physiotherapy, and most importantly, patient satisfaction. Results of recent meta-analyses demonstrated that using COAS for TKA significantly reduced the relative risk of excessive implant misalignment by 25% compared TKA. Infection after total knee replacement [IATJ] is a rare complication. Gentamicin, tobramycin and vancomycin are good alternatives as thermoresistant agents.