Early Femoral Failure in Two Patients Undergoing Downsizing of the Femoral Component During High-Flexion Total Knee Arthroplasty

Introduction and Importance: High-flexion prostheses can be associated with a greater risk of early aseptic loosening of the femoral component than standard prosthesis. Case presentation: We describe two patients in whom high-flexion total knee arthroplasty (TKA) was performed using the anterior referencing (AR) method that resulted in early aseptic loosening of the downsized femoral component. Conclusion: Excessive bone resection of the posterior femoral condyle by additional downsizing of the femoral component during high-flexion TKA using the AR method could lead to early failure of the femoral component.