The conainons or component positioning ana overall axial alignment tnat are important in primary and revision total knee arthroplasty and in addressing problems of malalignment and ligament incompetence are described. The component position description incorporates a simple tibiofemoral model with the tibia “suspended” via collateral ligaments. These ligaments are seen as originating from the femoral epicondyles, which can be thought of as the general neighborhood of the centers of rotation for flexion-extension movement. Ligament balancing by soft-tissue release, as well as by collateral ligament tightening, are discussed. The simpler techniques of soft-tissue release at the concave side of the deformity are the most common techniques for routine ligament balancing. Problems of component axial malalignment in the presence of stable ligaments; ligamentous instability in the presence of stable, well-aligned components; and frank tibiofemoral dislocation are also covered. A basic philosophy of avoiding, whenever possible, highly constrained implants is put forth, together with an emphasis on the idea of knowing when to move toward fusion as the operation of choice.