J Arthroplasty. 2008 Oct;23(7 Suppl):6-10. Long WJ, Scuderi GR.
High-flexion total knee arthroplasty is considered flexion beyond 125 degrees . Certain activities and a number of workplace demands benefit from this greater range of motion. Some cultures and religions place more emphasis on deep knee flexion. Important patient factors include preoperative motion, body mass index, and previous knee surgery. Component design modifications focus on lengthening the radius of curvature through the posterior condyles, increasing the posterior condylar offset, recessing the tibial insert, lengthening the trochlear groove, and altering the cam-post design. These changes allow increased femoral rollback, translation, and thus clearance in deep flexion. Surgical techniques focus on soft tissue balancing, component sizing and position, removal of impinging osteophytes, and reestablishment of the flexion gap. A number of outcome studies have demonstrated benefits for high flexion after standard total knee and high-flexion designs.