We report a case of fracture of the polyethylene tibial spine of a NexGen posterior stabilized UPS-Flex total knee (Zimmer, Warsaw, IN, U.S.A.) 3 years after total knee arthroplasty. Wear of the polyethylene was noted over the medial and lateral surfaces with burnishing and around the broken site of the tibial spine. Anterior tibial spine impingement in the posterior stabilized total knee arthroplasty is the possible mechanism of failure. Since the patient was obese and had medial instability, revision with constrained total knee arthroplasthy was done. After surgery the patient obtained an uneventful recovery with complete relief of previous symptoms. To our nowledge, this is the first report of polyethylene tibial spine fracture in NexGen UPS high flexion total knee prosthesis.