Total knee replacement (TKR) is one of the most commonly performed and successful orthopedic surgeries in the modern era. The rising prevalence of obesity has contributed to the need for TKR, but the anatomy of obese patients presents unique challenges during surgery. In this article, we will focus on surgical techniques and tools to maximize the success of TKR in this patient population. We will also cover the relationship between obesity and the development of knee osteoarthritis, postoperative care, and prosthetic outcomes.