Background: The effect of an anterior condylar height (ACH) change after total knee arthroplasty (TKA) is not well-known. The effect of an ACH change was evaluated on postoperative knee flexion, New Knee Society Scores (2011KSS), and patellofemoral contact force.Methods: The study included 101 knees that underwent TKA. The medial or lateral ACH was measured using pre-operative and postoperative computed tomography. Pearson correlation between the change in ACH and knee flexion was calculated. The determinant of the change in flexion was evaluated using multivariable linear regression. The association between ACH and 2011KSS was assessed. Using the cases with the three highest and three lowest preoperative medial ACHs, computer simulation was performed to detect the changes in patellofemoral contact forces.Results: A postoperative reduction in ACH correlated with increased flexion at one year (medial ACH, R = 0.58; lateral ACH, R = 0.48). On multivariable linear regression, reductions in medial ACH (beta = 1.7, P < 0.001) and pre-operative flexion (beta = 0.3, P < 0.001) were associated with increased flexion. A decrease in ACH was associated with improvements in advanced activities (medial, R-2 = 0.06; lateral, R-2 = 0.08) in 2011KSS. On computer simulation, all three cases with reduced and increased medial ACHs showed decreased and increased patellofemoral contact forces, respectively.Conclusions: A change in ACH was an independent predictor of knee flexion after TKA. Greater reduction in ACH was associated with improved flexion after TKA, whereas an increase in postoperative ACH may be a risk factor for flexion loss. (C) 2019 Elsevier B.V. All rights reserved.