Patient satisfaction after total knee arthroplasty: an Asian perspective

<p><b>INTRODUCTION</b>Total knee arthroplasty (TKA) is an effective method for alleviating pain and restoring knee function in patients with severe osteoarthritis. However, despite the improvements in surgical technique and postoperative care, it has been reported that up to 19% of patients are dissatisfied after their operations. The aim of this study was to evaluate patient satisfaction levels after TKA in an Asian cohort, as well as assess the correlation between patient satisfaction levels and the results of traditional physician-based scoring systems.</p><p><b>METHODS</b>The medical data of 103 Asian patients who underwent 110 TKAs between December 2008 and June 2009 were obtained from our hospital's Joint Replacement Registry. The minimum follow-up period was one year and patient expectations were assessed before TKA. Patient satisfaction was assessed postoperatively using a 5-point Likert scale. Reasons for patient dissatisfaction were recorded. Standardised instruments (e.g. the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and the generic Short Form-36 health survey) were used to assess the patient's functional status and the severity of symptoms pre- and postoperatively.</p><p><b>RESULTS</b>Among the 110 TKAs performed, 92.8% resulted in patient satisfaction. Patient satisfaction correlated with postoperative WOMAC function scores (p = 0.028), postoperative WOMAC final scores (p = 0.040) and expectations being met (p = 0.033).</p><p><b>CONCLUSION</b>Although there was a high level of patient satisfaction following TKA in our cohort of Asian patients, a significant minority was dissatisfied. Patient satisfaction is an important outcome measure and should be assessed in addition to traditional outcome scores.</p>

Vascular endothelial growth factor (VEGF) is expressed during articular cartilage growth and re-expressed in osteoarthritis

<p><b>INTRODUCTION</b>Vascular endothelial growth factor (VEGF) is expressed in osteoarthritic articular cartilage. However, the pattern of VEGF expression throughout the whole life cycle of articular cartilage is not well elucidated. The aim of the study was to investigate the spatiotemporal expression of VEGF and its receptors, vascular endothelial growth factor receptor-1 (VEGFR1) and vascular endothelial growth factor receptor-2 (VEGFR2), in articular cartilage during growth, maturation and degeneration, using the guinea pig model of spontaneous osteoarthritis.</p><p><b>MATERIALS AND METHODS</b>Sections of tibial plateaus aged 2, 6 and 12 months were obtained, representing growing, mature and osteoarthritic cartilage respectively. Expression of VEGF and its receptors was determined by immunohistochemistry and in situ hybridisation.</p><p><b>RESULTS</b>At 2 months, VEGF and its receptors were expressed in chondrocytes within the superficial layer of the articular cartilage. At 6 months, no expression of VEGF and its receptors was noted. In the 12-month-old specimens, VEGF and its receptors were expressed in chondrocytes within articular cartilage that exhibited osteoarthritic changes (medial tibial plateaus), but not in the histologically normal lateral plateaus.</p><p><b>CONCLUSION</b>This spatiotemporal distribution of VEGF and its receptors suggests that VEGF is expressed during articular cartilage growth, becomes quiescent at maturity, and is re-expressed in osteoarthritis.</p>