Total knee arthroplasty is a common and immensely successful surgical procedure that reliably relieves pain and improves function. However, early revision rates and patient dissatisfaction are high suggesting that there is need for improvement through careful patient selection and education as well as attention to surgical technique. After ensuring that a patient is an appropriate candidate for the procedure, patient education is critical to ensure appropriate expectations. Careful preoperative planning and achieving appropriate alignment, sizing, and ligament balance are critical for optimal knee function. Careful attention to the cement technique is important for long-term implant fixation. With appropriate patient selection and careful surgical techniques, optimal patient outcomes will be achieved.