Total knee replacement is an affective, predictable, reliable treatment for advanced knee osteoarthritis. The most common and widespread method is cemented arthroplasty, and it is accepted as golden standard for treatment of osteoarthritis of knee. With recent developments of biotechnologies, uncemented total knee arthroplasty is becoming an attractive option. The most important advantages of uncemented total knee arthroplasty are: bone stock preservation, obtaining biological fixation, cement debris protection, and shorter operation time. As the mean age of patients undergoing total knee arthroplasty is decreasing, the survival of implants is becoming a more important factor in selection of fixation. The related literature and meta-analysis revealed that the uncemented knee arthroplasty has comparable survival rate as cemented prostheses in short term follow up, and uncemented arthroplasty is suggested to young and obese patients. However, ideal fixation method is still debated, and most of the surgeons prefer cemented knee arthroplasty.