Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1504–1511

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

  • Bum-Sik Lee
  • Jong-Won Chung
  • Jong-Min Kim
  • Kyung-Ah Kim
  • Seong-Il Bin
Symposium: Special Considerations for TKA in Asian Patients

DOI: 10.1007/s11999-012-2661-4

Cite this article as:
Lee, BS., Chung, JW., Kim, JM. et al. Clin Orthop Relat Res (2013) 471: 1504. doi:10.1007/s11999-012-2661-4



Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.


We therefore determined (1) the rate of achieving postoperative HF after HF TKA; (2) whether the aseptic loosening rate of HF prostheses is high; and (3) whether the survivorship was worsened in patients who achieved postoperative deep knee flexion in our cohort of Korean patients.


We retrospectively reviewed 488 patients who had 698 primary TKAs using the NexGen® Legacy Posterior-Stabilized Flex system implanted from 2003 to 2010. There were 40 men and 448 women with a mean age of 68 years. We obtained Hospital for Special Surgery scores, maximal flexion, and radiographs. The minimum followup for functional and radiographic evaluations was 2 years (median, 4.8 years; range, 2–8.7 years). We performed a survival analysis on all patients for aseptic loosening.


Three hundred sixty knees (52%) could achieve ≥ 135° maximum flexion. Six of the 698 knees (0.9%) developed aseptic loosening (three femoral and three tibial). The survival at 5 years for aseptic loosening was 99.1%. The overall survival for aseptic failure did not differ between knees that achieved HF and those that did not.


We observed a low incidence of early aseptic loosening of HF designs in this series. Our findings suggest HF TKAs have high survival in Asian patients at 5 years although half of the patients attained maximum flexion more than 135° postoperatively.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Bum-Sik Lee
    • 1
  • Jong-Won Chung
    • 2
  • Jong-Min Kim
    • 3
  • Kyung-Ah Kim
    • 4
  • Seong-Il Bin
    • 3
  1. 1.Department of Orthopedic Surgery, College of MedicineCatholic UniversityIncheonKorea
  2. 2.Barun Joint OrthopedicsSeongnam-siKorea
  3. 3.Department of Orthopedic Surgery, College of MedicineUniversity of Ulsan, Asan Medical CenterSeoulKorea
  4. 4.Department of Biomedical Engineering, College of MedicineChungbuk National UniversityCheongju-siKorea