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Objective To assess the tibio‐femoral contact forces before and after total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA) by three‐dimensional (3D) finite element analysis (FEA) models and gait analysis. Methods Two hospitalized patients with Kellgren–Lawrence grade IV varus KOA and two healthy subjects were enrolled in this study. Both patients underwent unilateral TKA. FEA models were established based on CT and MR images of the knees of the patients with KOA and healthy subjects. Gait analysis was performed using a three‐dimensional motion capture system with a force plate. Three direction forces at the ankle joints were calculated by inverse dynamic analysis, which provided the load for the FEA models. The total contact forces of the knee joints were also calculated by inverse dynamic analysis to enable comparisons with the results from the FEA models. The total knee contact forces, maximum von Mises stress, and stress distribution of the medial plateau were compared between the patients and healthy subjects. The distributions of the medial plateau force at 2 and 6 months postoperatively were compared with the distributions of the forces preoperatively and those in the healthy subjects. Results During static standing, the medial plateau bore the most of the total contact forces in the knees with varus KOA (90.78% for patient 1 and 93.53% for patient 2) compared with 64.75 ± 3.34% of the total force in the healthy knees. At the first and second peaks of the ground reaction force during the stance phase of a gait cycle, the medial plateau bore a much higher percentage of contact forces in patients with KOA (74.78% and 86.48%, respectively, for patient 1; 70.68% and 83.56%, respectively, for patient 2) than healthy subjects (61.06% ± 3.43% at the first peak and 72.09% ± 1.83% at the second peak). Two months after TKA, the percentages of contact forces on the medial tibial plateau were 79.65%–85.19% at the first and second peaks of ground reaction forces during the stance phase of a gait cycle, and the percentages decreased to 53.99% – 68.13% 6 months after TKA. Conclusion FEA showed that TKA effectively restored the distribution of tibio‐femoral contact forces during static standing and walking, especially 6 months after the surgery. The changes in the gait were consistent with the changes in the contact force distribution calculated by the FEA model.