Background

Degeneration of the intervertebral disc (IVD) is a leading cause of lower back pain, and a significant clinical problem. Inflammation mediated by IL-1β and TNF-α drives IVD degeneration through promoting a phenotypic switch in the resident nucleus pulposus (NP) cells towards a more catabolic state, resulting in extracellular matrix degradation. Bone marrow mesenchymal stem cells (MSCs) produce bioactive factors that modulate local tissue microenvironments and their anti-inflammatory potential has been shown in numerous disease models. Thus MSCs offer a potential therapy for IVD degeneration. In a clinical setting, adipose-derived stem cells (ASCs) might represent an alternative and perhaps more appealing cell source. However, their anti-inflammatory properties remain poorly understood.

Aims:. To assess patients expections of knee arthroplasty surgery in the UK. Methods: A Hospital for Special Surgery Knee Replacement Expections questionnaire was mailed to all 252 patients currently awaiting knee arthroplasty surgery in Leicester. Results: Completed questionnaires were returned by 201 patients (80%). 60% of the patients were female. The mean age was 71 yrs. (range 44–95 yrs). 12 were aged 55 yrs or less and 37 80 yrs. or older. 35% of patients expected the arthroplasty to relieve all their pain, 62% most of their pain and 3% only some of their pain. 39% expected to walk long distances but 57% expected to be able to walk under 1 mile. 70% of patients expected to be able to kneel and 58% to squat. Only 40% of patients expected to take part in sporting activities, 50% in those under 55 yrs. Only 66% felt that participating in recreational activities such as dancing was important. 21% hoped that the arthroplasty would improve their sexual activity. 83% expected that it would improve their psychological well-being. Conclusions: Though 17% of patients in the UK are disappointed with their knee replacement 1 year after surgery their expectations appear to be lower than reported from the USA. UK patients expect their knee to get them back to being able to complete activities of daily living without pain but not much more. Our patients expectations in most areas are realistic but may reßect their deterioration in activity prior to being referred to orthopaedic surgeons for consideration for arthroplasty surgery.