Total knee replacement (TKR) is the standard surgical option for advanced knee osteoarthritis once conservative care stops working, and demand for it in India continues to rise. This paper reviews recent literature (2023–2026) on functional outcomes after TKR, with attention to Indian prospective cohorts. Peer-reviewed systematic reviews, meta-analyses and prospective studies were identified through database and repository searches and synthesised narratively. The evidence shows that patients usually report clear gains in pain and self-reported function within three to six months, whereas performance-based measures such as walking and chair-rise tests improve less consistently. Indian prospective series using the Knee Society Score, Oxford Knee Score and WOMAC report large improvements in scores and range of motion, even among patients with severe deformity and low socioeconomic status. Alignment strategy, robotic assistance and sensor-guided balancing may add modest benefits, but the data are still heterogeneous. Poor rehabilitation adherence, limited access to physiotherapy, out-of-pocket costs and small single-centre samples remain the main barriers. The review concludes that TKR reliably improves function in advanced osteoarthritis and that structured, affordable rehabilitation and multicentre prospective follow-up are the priorities for Indian practice.