The embodiment of the invention provides a total knee arthroplasty preoperative planning method and device, and the method comprises the steps: obtaining a knee joint X-ray film image, and determining the real size of the knee joint X-ray film image; inputting the knee joint X-ray film image into a neural network identification model for identification, and determining key points and key axes; determining femur size parameters and tibia size parameters based on the key points and the key axes; determining types and models of a thighbone prosthesis and a tibia prosthesis based on the thighbone size parameter and the tibia size parameter; and based on the key axis, the type and the model of the femoral prosthesis and the type and the model of the tibia prosthesis, determining placement positions and placement angles corresponding to the femoral prosthesis and the tibia prosthesis. Therefore, according to the embodiment of the invention, the cost can be saved, the randomness of manual measurement is avoided, and an important reference function is provided for calculation of various parameters and placement of the prosthesis, so that the dependence on a surgeon is reduced.