OBJECTIVE To present the results of total knee replacement at the King Abdul-Aziz University Hospital in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS The medical records of 205 patients who received 309 prostheses was reviewed. The study took place at King Abdul-Aziz University Hospital, Jeddah, KSA between May 1989 and August 2005, where patients were either examined in the outpatient clinic or interviewed on the phone. Seventeen patients (22 prostheses) were lost for follow up. The scores were registered according to the Knee Society Clinical Rating System. RESULTS There was a significant improvement in all-functional scores postoperatively in the first year, which continues without significant change throughout the follow up period. Symptomatic deep vein thrombosis was observed in 5 patients, 3 of them had pulmonary embolism, which was fatal in 2 cases. Early deep infection occurred in 3 cases. Superficial wound infection was seen in one patient. One patient suffered peroneal nerve palsy, while 4 patients had aseptic loosening of the femoral implant. One patient had rupture of the patellar tendon. Metal breakage was observed once and one patient is diagnosed to have polyethylene wear. In the early phase, when a prosthesis type without dislocation protection was used, 7 dislocations occurred. This type was not used anymore and no such complication was observed. CONCLUSIONS Total knee replacement relieves pain and improves quality of life significantly. The observed complications compare well with the results reported in the literature.