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In Reply:

Thank you for your interest in our article “A Randomized Controlled Trial Comparing “High-Flex” vs “Standard” Posterior Cruciate Substituting Polyethylene Tibial Inserts in Total Knee Arthroplasty,” published recently in the Journal of Arthroplasty. We agree that cultural differences, specifically, the differences in the importance of obtaining knee flexion after surgery between Western and Eastern societies, are important factors to consider. Unfortunately, we do not routinely measure the knee flexion of the contralateral limb (assuming it is normal) so we cannot comment on the premorbid flexion of the affected side. With the respect to the role of “necessity,” that we have performed a randomized control trial would make it unlikely that either group had a predisposition for achieving more postoperative flexion compared to the other. Of interest, we have recently published another article, “The Role Of Polyethylene Design On Post-Op TKR Flexion: An Analysis of 1534 Cases” that demonstrated a larger influence of component design to postoperative flexion after total knee arthroplasty.

Yours sincerely,

Richard W. McCalden, MD