The success of total knee arthroplasty has contributed to its widening application to a younger, more active patient population whose daily regimen includes more demanding high flexion activities. Worldwide expansion to Middle Eastern and Asian populations, where the attainment of high knee joint flexion is often a cultural requirement, has been steadily increasing in recent years. This in turn has led to design changes in contemporary polyethylene tibial inserts which accommodate these increased flexion ranges. This study reveals the contact areas and stresses that are associated with polymer insert abrasion and subsurface delamination for four contemporary total knee designs during the most highly loaded portions of three different high flexion activities, and suggests their efficacy in clinical use.

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