Can a high-flexion total knee arthroplasty relieve pain and restore function without premature failure?

High-flexion TKA prostheses are designed to improve flexion and clinical outcomes. Increased knee flexion can increase implant loads and fixation stresses, creating concerns of premature failure. Whether these goals can be achieved without premature failures is unclear.

We assessed pain relief, knee motion, function, incidence of premature failure, and radiographic appearance in patients with a mobile-bearing high-flexion TKA and determined whether preoperative knee flexion affects postoperative knee flexion.

We prospectively followed all 142 patients implanted with 154 mobile-bearing high-flexion TKAs between 2004 and 2007. We obtained Knee Society scores (KSS) and assessed radiographs for loosening. Minimum followup was 24 months (mean, 46 months; range, 24-79 months).

Average knee flexion improved from 123° to 129°. Patients with preoperative flexion of 100° to 120° had a greater postoperative flexion increase (mean, 13°; range, 114°-126°) than patients with preoperative flexion of greater than 120° (mean, 3.0°; range, 128°-131°). The mean KSS improved from 41 to 95 postoperatively. Patients with preoperative flexion of less than 120° had a greater improvement in KSS (62 versus 48). Posterior femoral radiolucent lines were observed in 43% without evidence of prosthetic loosening.

Our data were similar to those reported in patients implanted with traditional and other designs of high-flexion TKA. We found no increased incidence of premature failure, although a higher than expected incidence of posterior femoral radiolucent lines merit continued observation. Patients with less preoperative motion were more likely to benefit from a high-flexion TKA.