Objective To compare the therapeutic effect of unicompartmental knee arthroplastyt and total knee replacement on knee arthritis for patients with kashin-beck disease in loess plateau area. Methods A total of 40 patients with KBD knee joint arthritis of Kaschin-Beck disease who were admitted to the People's Hospital of Qingyang City from January to September 2018 were selected as subjects. The patients were divided into the UKA group and the TKA group according to the operation method, and the two groups were compared in terms of intraoperative operation time, postoperative drainage volume, knee joint activity, HSS score, the amount of hemoglobin, the value of c-reactive protein, etc. Results Compared with preoperative hemoglobin, knee range of motion, HSS score and c-reactive protein, patients in the UKA group and the TKA group had similar conditions and were comparable (P > 0.05). Compared with the TKA group, the operative time and postoperative drainage were significantly lower in the UKA group than in the TKA group (P < 0.05). Compared with patients in the TKA group, patients in the UKA group had higher knee range of motion and HSS score than those in the TKA group (P < 0.05). Compared with patients in the TKA group, patients in the UKA group showed a significantly lower degree of hemoglobin decrease than those in the TKA group (P < 0.05). Compared with the postoperative c-reactive protein in the TKA group, the level of c-reactive protein in the UKA group was lower than that in the TKA group (P < 0.05). Conclusion Both unicompartmental knee arthroplasty and total knee replacement have good therapeutic effects on patients with KBD. But compared with total knee replacement, unicompartmental knee arthroplasty has obvious advantages in the treatment of KBD patients. Therefore, unicompartmental knee arthroplasty is more worthy of promotion and application in the treatment of KBD.