OBJECTIVE: To compare the clinical application of TKA two types of tibial prosthesis rotation. METHODS: One hundred patients with unilateral TKA who underwent unilateral knee osteoarthritis were followed up for 1 year. Group A used the 1/3 line of the tibial tuberosity as an anatomical landmark, and group B took the humeral prosthesis. Spin placement, localization of the external margin of the humerus intercondylar, the small prosthesis was used, the posterior medial horn of the humerus was exposed, and the midpoint of the tibial tuberosity was used as an anatomical landmark. The knee ROM, HSS score, and WOMAC score were recorded 1 year after surgery to evaluate the TKA effect 1 year after surgery. RESULTS: The midpoint of the tibial tuberosity was used as the anatomical landmark group. The joint mobility, HSS score and WOMAC score were better than 1/3 of the tibial tuberosity in 1 year after operation. Conclusion: The external fixation of the humerus in the external rotation, the midpoint of the tibial tuberosity as an anatomical landmark for the placement of the tibial prosthesis is effective, and further clinical research can be carried out.