Osteoarthritis of knees affects predominantly the senior citizen age group. Total knee replacement is a permanent solution to the aged suffering to provide permanent pain relief. The elderly become pain free and the quality of life improves. However there has been a universal feeling amongst south Indians that the majority of implants available in India and Chennai do not allow more than 100 degrees of knee bending. The patients say that they are unable to squat on the floor or climb stairs easily with the operated leg going up first and have to drag it behind the good one. Even computer assisted surgery cannot achieve these unless the prosthesis is designed to provide this extra bend. They may have difficulty in climbing stairs, using Indian toilet and squatting on the floor. This is a great disadvantage to majority of South Indians who prefer to squat on the floor for prayer, social activities and meals.

So, many people refrain from undergoing the surgery and suffer in silence. Now with the advent of a new type of prosthesis, patients in South India undergoing a knee replacement need not be functionally impaired. A new design of prosthesis allows knee bending up to 155 degrees. The patient has to be motivated to regain high knee flexion and participate in early and aggressive physiotherapy. They should not be obese and the pre operative knee bend should be above 90 degrees. This prosthesis is implanted by special instrumentation which is minimally invasive and does not damage the tissues. Hence post operative pain is less and rehabilitation is faster.

This prosthesis is different to the many claims of rotating platform prosthesis.

Preoperative considerations for a High flexion knee replacement- Not all patients can get a high degree of flexion after a knee replacement. To qualify for this procedure, the patients must not be obese, have a thigh calf index of > 90 degrees and should be motivated to participate in physiotherapy in the early days after surgery, bearing post op pain. The wound is likely to weep slightly more as it would be subject to stretching. Cycling is an activity that promotes the building of