Background: Knee osteoarthritis (OA) is one of the leading causes of pain and disability that significantly impacts mobility, independence, and quality of life. Total knee arthroplasty (TKR) is considered the gold standard treatment for end-stage knee OA, with proven benefits in pain relief and functional restoration. This study aimed to evaluate the clinical and functional outcomes of TKA in patients with advanced knee OA treated at our institution. 
Methods: This was a prospective study conducted at Manipal Teaching Hospital from March 1, 2021, to March 30, 2024. A total of 74 patients with severe knee OA, unresponsive to conservative management, underwent TKA and were followed up for 6 months. Clinical and functional outcomes were assessed using the Knee Society Score (KSS), Visual Analog Scale (VAS) for pain, and range of motion (ROM). Data were analyzed using SPSS v20, with p <0.05 considered statistically significant. 
Results: The mean age of patients was 72.07 ±5.54 years, with females comprising 66.2% of cases. Pre-operative mean knee flexion improved significantly from 89.07° ±15.17 to 113.74° ±8.25 postoperatively (p =0.000). Mean extension improved from 10.26° ±7.44 to –0.80° ±1.95. The mean KSS improved from 42.54 ±4.95 to 87.76 ±3.44, while functional KSS improved from 35.28 ±4.38 to 82.89 ±2.83 (both p = 0.000). VAS decreased from 6.99 ±1.06 to 0.35 ±0.65 (p =0.000). Post-operative complications included superficial infection in two patients (2.7%) and deep infection in one patient (1.35%) requiring prosthesis removal and arthrodesis. No cases of deep vein thrombosis were recorded. 
Conclusion: TKA provides significant improvements in pain relief, ROM, and functional outcomes in patients with advanced knee OA. With low complication rates, it remains a safe and effective surgical option in our setting. 
Keywords: Knee joint, Osteoarthritis, Total knee arthroplasty