Objective To investigate the effect of the tibiofemoral joint surface with high conformity on total knee prosthesis motion and insert wear. Methods A type of knee prosthesis with a high coronal conformity was designed and manufactured, and its insert wear was studied by in vitro wear testing combined with finite element simulation. ResultsThe mass wear rates calculated by the in vitro wear testing and finite element simulation were (14.29±3.19) mg/MC and 14.67 mg/MC (MC, million cycle), respectively. After five MCs, the areas of the insert wear obtained by both the methods were basically consistent, and severe wear was found to occur in the middle part of the insert. ConclusionsThe result of the finite element simulation coincided with that of the in vitro testing. The wear rate of the tibiofemoral joint surface of the total knee prosthesis with a high coronal conformity was relatively low. The research outcomes have practical significance for the evaluation and clinical application of the total knee prosthesis with a high conformity.