BackgroundTotal knee replacement (TKR) results in an excellent outcome in terms of pain relief. The reporting of outcomes was traditionally focused on implant survivorship and objective outcomes such as range of motion, knee stability, and radiographic alignment. However, patients and doctors had differing perceptions of all domains of outcome, especially subjective quality of life domains such as emotions and social functioning. In this study, we tried to find out the expectations of Indian patients regarding TKR and assess the level of satisfaction among our patients from their view point using focus group discussion (FGD), and whether these expectations have an impact on outcomes and patient satisfaction.Materials and methodsThis study was conducted in the Department of Orthopedics, Government Medical College, Kozhikode, Kerala, India, in November 2014. Patients between the ages 60 and 65 years who met inclusion criteria were selected. A total of 50 patients were selected for FGDs. Among them, 42 patients participated in FGD. The remaining eight did not appear for the discussion. A total of four FGD sessions were conducted.Results and discussionIt was found that there is a discrepancy between the satisfaction levels of patient and surgeon. There is a difference in satisfaction level achieved depending on socioeconomic, geographic, and cultural characteristics.ConclusionNewer methods of TKR outcome assessment combining radiological outcome, surgeon-based assessment, and patient satisfaction based on their socioeconomic status and cultural characteristics should be developed for different populations.

Metastasis is the commonest bone tumors. The commonest primary metastasis to the bone are the breast, lung, prostate, kidney, and thyroid. The bone is the third common site of metastatic disease, only the lung and the liver have higher metastatic rate than skeleton. We have no epidemiological studies conducted to evaluate the various aspects of skeletal metastasis like age, sex distribution, presentation, common sites of primary and associated secondary metastases, and investigation from Indian subcontinent. Here we are presenting the first epidemiological study of skeletal metastasis from our region. We have conducted a prospective descriptive study in the Departments of Orthopedics and Radiotherapy, Government Medical College, Kozhikode, during the period of 2007 to 2009. One hundred eleven patients were included in the study above the age of 30 years. Clinical examination and investigation were done on these patients. Skeletal metastasis commonly occurs in the fifth decade of life with modest male preponderance. In most of the cases, the primary site of malignancy was undetected at the time of presentation. Pain was the commonest presented complaint of the patient. The spine is the commonest site affected and the lung was the common site of primary metastasis. Most of the cases were detected by radiogram and confirmation was obtained by minimally invasive technique like FNAC or CNB.

Background:Most important cause of treatment failure and emergence of drug resistance in the treatment of tuberculosis is noncompliance. Compliance can be improved by direct observation of drug intake, intermittent therapy, and short-course treatment. The efficacy of Directly Observed Treatment Short Course (DOTS) strategy advocated by World Health Organization (WHO) in spinal tuberculosis is not yet proven. We conducted a prospective clinical study on a consecutive series of patients with spinal tuberculosis treated by Category I Revised National Tuberculosis Control Programme (RNTCP) regimen based on DOTS strategy of WHO from 2004 to 2007 to evaluate the efficacy.Materials and Methods:Forty-nine consecutive patients of spinal tuberculosis were treated with short-course intermittent chemotherapy under Category I RNTCP/DOTS strategy. Patients were followed up for a minimum period of 2 years. Surgery was done if the patient presented with significant neurologic deficit or when the drug treatment failed. Outcome was assessed by clinical, radiologic, and laboratory criteria, and graded into excellent, good, fair, and poor based on various parameters.Results:63.4% (n=26) of the patients had excellent results. 14.6% (n=6) of the patients had good and fair results. Three patients (7.3%) had poor results 48.7% (n=20) of the patients had but only one of them was severe enough to warrant change of drug.Conclusions:Efficacy of DOTS was comparable with other standard regimens. There was a significant reduction in adverse side effects when compared with daily regimens. Study showed that the outcome was better in those treated early.

The disease has distinct regional variations, and the epidemiological and bacterial profile is constantly changing. There is a shift in causative organisms towards more resistant and gram-negative species. Prematurity, low birthweight and previous hospitalisation are the major predisposing factors. A better understanding of the varied presentations is necessary for an early diagnosis and treatment, which is the most important prognostic factor.

Patient-based outcomes (patient-reported outcomes) of any intervention can change according to factors like age, gender, region, culture, education, and socioeconomic status. Most of the available outcome measuring tools have a surgeon-related bias. Focus group discussion (FGD) is a simple and effective way to assess the outcome of an intervention. In FGD, people from similar backgrounds and experiences discuss a specific topic of interest. Our objective is to discuss the problems of common outcome measuring tools for patient satisfaction and to understand the method of conducting an FGD. We have set our own published article on patient-based outcomes after total knee arthroplasty (TKA) as an example for explaining the method of conducting an FGD. The planning, advantages, disadvantages, practicalities, and problems of conducting an FGD are explained. In conclusion, many of the tools used for assessing patient satisfaction is surgeon-centered. Focus group discussion is simple, cost-effective, requiring a small number of participants, and can be completed in a short period. It is an effective tool for assessing patient-based outcomes in TKA.