This chapter presents a case scenario of a 55‐year‐old Muslim woman who presents with end‐stage degenerative joint disease of her knee. High‐flexion (HF) total knee arthroplasty (TKA) implants were designed and marketed for patients who desire to continue leisure and sporting activities or to return to cultural norms such as prayer. An easily measured shortfall of contemporary TKA is the range of motion routinely obtained after surgical intervention and its comparison to the amounts required to perform routine activities of daily living. Although the theoretical advantage of HF TKAs is to obtain greater flexion and improve clinical outcomes, controversy exists whether such designs truly change functional outcomes. Any TKA that undergoes deep flexion is subject to high shear forces between the tibia and femur, which may result in early loosening. The chapter provides recommendations for implementing evidence‐based practice in the clinical setting.