The in-vivo performance of Ti-6Al-4V titanium alloy as a bearing surface for total knee replacement was evaluated by analysis of 29 retrieved Miller-Galante prostheses. Retrieved implants were subjected to routine analysis, and a qualitative damage score was assigned to each component. The mean time from the primary procedure to the revision was 54 months. Nineteen of 29 revisions were performed for complications relating to metal-backed patellar component failure.