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.

Comminuted intra articular fractures of the distal end of radius AO type C3 is a very gruesome injury considering the difficulty in treatment and the results. Treatment decisions are often difficult and they may end up in loss of range of movement and CRPS, if not properly addressed. Complete anatomical reduction is difficult in these types of fractures and the methods adopted are external fixation or internal dorsal distraction plating, the latter being a relatively newer method. Aims: To study the functional and radiological outcome of dorsal distraction plating of comminuted distal end of radius fractures AO type C3. Patients and Methods: A single cohort longitudinal study of 24 Patients who sustained AO C3 type fractures of distal end of radius and have undergone dorsal distraction plating were selected and followed up for a period of 1year. Functional assessment was done using Green O'Brien score and radiological assessment was done using Sarmiento score. Results: One year follow-up of 24 patients showed average palmar flexion of 56 0 , dorsiflexion 60 0 , radial length of 10mm, radial inclination of 15 0 , volar tilt of 3 0 and ulnar variance of 0.5mm. Functional scoring using Green O'Brien score showed more than 80% good to excellent result and radiological assessment by Sarmiento scoring showed 95% good results. Conclusion:Internal dorsal distraction plating in AO type C3 fractures yield better result compared to external fixation or volar locking plates. Functional and radiological outcomes are better in this type of fractures after dorsal distraction plating.