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This article displays a review of the specialty literature regarding the surgery of primary total knee arthroplasty (TKA), and more specifically refers to the complicated cases of primary total knee replacement where due to some preexisting pathologic circumstances, the orthopaedic surgeon must anticipate the risks and enhance the stability of the implant to obtain a long lifespan without revision surgeries. We collected the findings throught literature and compared them to our own surgical experience to create a rationale for the selection of the best knee prosthesis in surgical practice.