Total knee replacement is one of the most effective measures for the treatment of end-stage osteoarthritis. However, poor rotation alignment of the tibial prosthesis can cause long-term chronic pain of the knee joint after operation, instability of the tibiofemoral joint, aseptic loosening of the prosthesis, excessive abrasion of the prosthesis, and even joint dislocation and gasket dislocation.At present, there is still controversy about the precise placement method of the tibial prosthesis and tibia prosthesis rotation force line reference axis. This article will review the main methods and research progress of the tibial prosthesis rotation positioning, and the main methods include intramedullary positioning and marrow external anatomical landmark positioning, self-alignment technology, computer navigation technology, and personalized 3D printing technology, with a view to providing a reference for clinicians.