ObjectiveThis study aimed to explore the application and complications of high-flexion rotating platform (RPF) and standard rotating platform (RP) prostheses during total knee arthroplasty (TKA) for valgus knee.MethodsThe clinical data of 150 patients who underwent TKA for valgus knee in the hospital between January 2020 and January 2023 were retrospectively analyzed. Seventy-nine patients who received an RP prosthesis during TKA for valgus knee between January 2020 and June 2021 were included in the control group, and 71 patients who received RPF during TKA for valgus knee between July 2021 and January 2023 were enrolled in the observation group. The surgery-related indicators (surgical time, intraoperative blood loss, and the time required for 90° spontaneous knee flexion) were compared between the groups. Knee function was evaluated in the two groups using the American Knee Society Score (KSS) scale and the Hospital for Special Surgery (HSS) scale, and measuring the range of motion (ROM) of the knee joint and the ability to perform high-flexion activities. The differences in lower limb alignment [hip-knee angle (HKA), femorotibial angle (FTA)] were compared, and postoperative complications were recorded.ResultsThere were no statistically significant differences between the groups in terms of surgical time, intraoperative blood loss, time required for 90° spontaneous knee flexion, preoperative KSS, HSS score, ROM, preoperative HKA, and FTA (P>0.05). After surgery, the KSS and HSS scales in both groups were improved, the ROM angle was increased, and the HKA and FTA were reduced. However, there were no statistically significant differences in the change ranges and high-flexion activity ability between the groups (P>0.05). The incidence rate of patellar crepitus after surgery in the observation group was higher than in the control group (P<0.05).ConclusionRPF and RP prostheses during TKA for valgus knee effectively improved knee function and corrected lower limb alignment. There was no obvious difference in the treatment effect between the two kinds of prostheses. However, the incidence rate of patellar crepitus with the PRF prosthesis was relatively high. In clinical practice, doctors still need to determine the appropriate prosthesis for each patient’s specific situation.