Totalknee arthroplasty (TKA) is generally considered a durable procedure with reported implant survivorship in many series of 90% or greater at 20-year follow-up. However, implant failure can occur through a variety of mechanisms including bearing surface and backside wear, polyethylene fracture and particulate-generated osteolysis. Implant design, polyethylene quality and manufacturing methods, third-body wear debris, and patient-specific factors have all been shown to influence the durability of the TKA bearing surface. This chapter will provide an overview of the modes of TKA failure related to bearing surface issues, evaluate factors which may affect the longevity of the TKA bearing, and explore newer and future technologies that could potentially lower the incidence of bearing-related failure following TKA.