Total knee arthroplasty (TKA) is one of the most successful surgical interventions in orthopaedic practice for relieving pain and restoring function in degenerative and inflammatory knee disorders. The evolution of TKA design began with 19th-century resection and interposition arthroplasties and progressed to fully constrained hinge systems developed in the mid-20th century. However, these early designs demonstrated limited long-term success due to biomechanical incompatibility, aseptic loosening, and high complication rates. The introduction of the total condylar prosthesis in the 1970s marked the beginning of the modern TKA era. Improved understanding of native knee kinematics shifted the design philosophy from purely mechanical stability toward replication of physiological motion patterns. Posterior-stabilized systems were developed to restore the roll-back mechanism, while cruciate-retaining and posterior-stabilized concepts became the foundation of contemporary clinical practice. Mobile-bearing systems aimed to reduce contact stress, whereas medial pivot designs sought to more closely reproduce native knee kinematics. Currently, TKA designs are largely in an optimization phase, with particular emphasis on polyethylene wear, implant congruency, and patellofemoral articulation. Advanced biomaterials, including ceramic and oxidized zirconium surfaces, patient-specific implants, and robotic-assisted surgical technologies are expected to shape future directions.