{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T15:47:47Z","timestamp":1760888867021},"reference-count":25,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"2","license":[{"start":{"date-parts":[[2014,2,1]],"date-time":"2014-02-01T00:00:00Z","timestamp":1391212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:p>The outcome of total knee replacement (TKR) using components designed to increase the range of flexion is not fully understood. The short- to mid-term risk of aseptic revision in high flexion TKR was evaluated. The endpoint of the study was aseptic revision and the following variables were investigated: implant design (high flexion vs non-high flexion), the thickness of the tibial insert (\u2264 14 mm vs &gt; 14 mm), cruciate ligament (posterior stabilised (PS) vs cruciate retaining), mobility (fixed vs rotating), and the manufacturer (Zimmer, Smith &amp; Nephew and DePuy). Covariates included patient, implant, surgeon and hospital factors. Marginal Cox proportional hazard models were used.<\/jats:p><jats:p>In a cohort of 64 000 TKRs, high flexion components were used in 8035 (12.5%). The high flexion knees with tibial liners of thickness &gt; 14 mm had a density of revision of 1.45\/100 years of observation, compared with 0.37\/100 in non-high flexion TKR with liners \u2264 14 mm thick. Relative to a standard fixed PS TKR, the NexGen (Zimmer, Warsaw, Indiana) Gender Specific Female high flexion fixed PS TKR had an increased risk of revision (hazard ratio (HR) 2.27 (95% confidence interval (CI) 1.48 to 3.50)), an effect that was magnified when a thicker tibial insert was used (HR 8.10 (95% CI 4.41 to 14.89)).<\/jats:p><jats:p>Surgeons should be cautious when choosing high flexion TKRs, particularly when thicker tibial liners might be required.<\/jats:p><jats:p>Cite this article: Bone Joint J 2014;96-B:217\u201323.<\/jats:p>","DOI":"10.1302\/0301-620x.96b2.32625","type":"journal-article","created":{"date-parts":[[2014,2,3]],"date-time":"2014-02-03T10:09:09Z","timestamp":1391422149000},"page":"217-223","update-policy":"http:\/\/dx.doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Increased risk of revision for high flexion total knee replacement with thicker tibial liners"],"prefix":"10.1302","volume":"96-B","author":[{"given":"R. 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