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Over the years, the total knee arthroplasty (TKA) has become a common procedure for patients of various ages, ethnicities, and sex. Early prosthetic designs were limited in size and shape, leaving the surgeon to subjectively decide which component to use and sometimes having to compromise on the surgical technique to achieve a secure and stable construct. As studies began to investigate differences in tibial and femoral dimensions of the knee between specific populations, TKA implants incorporated these findings to become more anatomically accurate. When considering the global TKA patient population and the anthropometric differences between sexes and ethnicities, using anatomically proportioned femoral or tibial components with accurate trends in size and shape increases surgical accuracy to the measured anatomy, and ultimately influences clinical performance. This review will highlight the important clinical differences regarding knee anatomy between certain populations, along with the corresponding improvements in total knee component design.