The objective of knee joint arthroplasty is to eliminate pain and to maintain or restore knee stability and the best possible joint mobility. Until recently, it has often proved difficult to attain these goals, above all to retain them over a long period of time. Experiences reported the last 10 years describing a large number of knee joint arthroplasties [2, 3, 6–8, 10–12, 14, 21, 22, 26, 29, 41, 42, 50, 51, 56, 57, 59, 60, 61, 63, 68, 72] indicate that the complicated structure of the knee joint requires the application of appropriately complex surgical techniques with a high possibility of failure [15, 20, 32, 67, 73, 74, 77, 79, 82, 84]. In particular, as in the hip joint, it has been shown that loosening of the implant constitutes a major problem in knee joint arthroplasty. Loosening of the implant is a very frequent feature occurring in long-term follow-ups, especially for hinge prostheses with long anchoring stems [4, 13, 25, 28, 30, 31, 48, 49, 64, 69, 75]. Knee joint arthroplasty has clearly advanced sufficiently to allow more physiologically related movement through the preservation of the natural stabilising elements, i. e. muscles, tendons and ligaments, especially the collateral ligaments and, independent of the corresponding prosthesis model, the cruciate ligaments, in particular the posterior cruciate ligament (PCL). It has also been possible to preserve or largely restore normal kinematics in the knee joint [27, 38, 44, 46, 66, 76, 81], which also provide good preconditions for long-term success of the knee reconstruction [39, 40, 78]. However, to preserve or restore normal kinematics the tensioning of the ligaments should be coordinated, and as little bone as possible should be resected; thus, knee joint arthroplasty has become ever more elaborate in terms of surgical techniques and requires increasingly sophisticated instruments [24, 43].