Background This article focuses on clinical implementation of smart knee implants for total knee replacement and the future development of smart implant technology. With the number of total knee replacements undertaken growing worldwide, smart implants incorporating embedded sensor technology offer opportunity to improve post-operative recovery, reducing implant failure rates, and increasing overall patient satisfaction. Methods A literature review on smart implants, historical prototypes, current clinically available smart implants, and the future potential for conventional implant instrumentation with embedded sensors and electronics was undertaken. Results The overview of current and future technology describes use cases for various diagnostic and therapeutic treatment solutions. Conclusion Smart knee implants are at an early development stage, with the first generation of smart implants being available to patients and with more novel technologies under development.