Total knee arthroplasty (TKA) is a widely performed surgical intervention designed to relieve pain and restore function in patients with severe knee joint degeneration, most commonly due to osteoarthritis. This procedure involves replacing the damaged knee joint with a prosthetic implant, providing significant improvements in mobility and quality of life. While TKA is beneficial for many, the individuals who stand to gain the most are those with advanced knee arthritis unresponsive to conservative treatments, typically aged 60 and above, experiencing activity-related pain and functional limitations. Identifying patients with the highest potential for positive outcomes is critical to maximizing the benefits of this transformative surgery. Goal of this editorial is to give a critical view on today's common practice of arthroplasty surgery.