Between 1987 and 1995, 62 unilateral total knee replacements performed in patients older than 85 years (mean age, 87 years) were followed up for a minimum of 2 years (range, 2-11 years, mean, 5.4 years). This group represented 3.8% of all the total knee replacements performed during the same time. The majority of the patients were women with osteoarthritis. There was a 70% preoperative cardiac disease comorbidity. Overall, confusion after surgery was greater in this older group than in the patients younger than 85 years of age, however, confusion was lower in the group of patients who had epidural anesthesia as compared with those patients who had surgery under general anesthesia. The mean knee score at followup was 89 points and the mean pain score was 43 points (of 50 points). The mean flexion was 114 degrees. Seventy-five percent of these elderly patients still required the use of a cane for walking outdoors compared with 18% of the patients who were younger than 85 years. More than 855 of the older patients could travel independently to socialize and shop after surgery. Seventy-six percent of the patients were living independently or in senior retirement housing after surgery. Only two of the patients required living accommodations in a nursing home. One third of the patients still could drive their own car after surgery. Quality of life improvement was markedly increased in this elderly group of patients. The results of this study indicate that total knee replacement still is a valuable procedure even for this elderly group, and most of these patients returned to a more functional lifestyle.