Knee Surg Sports Traumatol Arthrosc (2011) 19: 936.

High-flexion total knee arthroplasty improves flexion of stiff knees

Lee, BS., Kim, JM., Lee, SJ. et al.


High-flexion knee prosthesis designs are generally thought to be of benefit only in patients with a satisfactory preoperative flexion angle. The aim of the study was to evaluate whether high-flexion designs were indeed worthless in osteoarthritis patients with severe preoperative flexion limitation.


The postoperative maximum flexion was compared in osteoarthritis patients with a preoperative maximum flexion of 100° or less, using LPS and LPS-flex implants (NexGen®; Zimmer, Warsaw, IN) in total knee arthroplasties. Data on 39 knees in the LPS group and 41 in the LPS-flex group, with a minimum of 2 years of follow-up, were reviewed retrospectively, focused on the postoperative maximum flexion.


Two years after operation, the LPS-flex group had a mean postoperative maximum flexion of 131 ± 10° (range, 105–140°), which was significantly higher than the 121 ± 12° (range, 95–140°) in the LPS group (P < 0.001). In the LPS-flex group, about half of the knees (n = 18, 44%) could achieve a maximum flexion of 140° postoperatively, but in the LPS group only five knees (13%) achieved a maximum flexion of 140°.



Despite a different period of the operation between groups, this study suggested that osteoarthritis patients with severe preoperative flexion limitation could achieve more postoperative gain in flexion when a high-flexion prosthesis was used, compared to the flexion obtained using a standard prosthesis.

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