The success of total knee arthroplasty has contributed to its widening application to a younger, more active patient population who 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 study reveals the contact areas and stresses that are associated with polymer insert abrasion in four 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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