Aim: A prospective cohort study on the role of flowtron intermittent compression garment (Flowtron) in improving fixed flexion deformity (FFD) in patients coming in for Total Knee Replacement (TKR).

Methods: A total of 36 patients with FFD of the knee averaging 26 deg. (range: 22 to 38 deg.) were included. There were 22 men & 14 women, with a mean age of 66 yrs (58 to 78). The diagnosis was osteoarthritis in 26 knees and rheumatoid arthritis in 10. The right knee was involved in 24 patients and the left in 12.There were 26 varus knees and 10 valgus. Patients with peripheral vascular disease and congestive cardiac failure were excluded from the study.

Results: Use of flowtrons for one week at home resulted in 80% mean improvement in fixed flexion deformity from an average 26 to 6 degrees (p< 0.001). The residual correction was obtained on the table without excessive posterior release or bone resection. The correction was found to be maintained at 6 months and 1year follow-up. There were no complications with Flowtron treatment. We also noticed that the improvement was better in Osteoarthritis group (26 to 5 degrees) as compared to Rheumatoid arthritis (31 to 9 degrees).

Conclusions: Conventional TKR in patients with moderate to severe FFD requires extensive posterior soft tissue release and bone resection. This prolongs surgical time, increases blood loss and has potential soft tissue complications. Flowtron has been used in the past to improve FFD with good early correction but the deformity gradually recurred. We have overcome this problem by doing definitive surgical procedure in the form of TKR. In summary, flowtron is safe and effective in reducing FFD, helping the surgeon to perform TKR without extensive posterior soft tissue release or bone resection with its attendant complications. The correction is maintained with no complications with its use. We recommend that flowtron be used in patients with moderate to severe FFD.

We present a prospective review of the outcome of 76 Lubinus patellofemoral arthroplasties carried out in 59 patients between 1989 and 1995. At a mean follow-up of 7.5 years, 62 knees in the 48 patients were reviewed; 11 patients (14 knees) had died. None was lost to follow-up.

The clinical outcome using the Bristol Knee Scoring system was satisfactory in 45% of the cases. Maltracking of the patella, resulting in lateral tilt, subluxation and polyethylene wear, was the most common complication (32%). Revision surgery was carried out in 21 knees (28%) giving a cumulative survival rate of 65% (confidence interval (CI) 49 to 77) at eight years. The survival rate for revision and moderate pain was 48% (CI 36 to 59) at six years. Progression of arthritis was seen in seven cases (9%). In five of these (6.5%), the symptoms were severe enough to need revision surgery. Due to the high proportion of unsatisfactory results, we have discontinued the use of this prosthesis.

The appearance and the biochemical, cytological and bacteriological findings were studied in synovial fluid obtained from the knees of 72 patients from south-west India. We report a group of 12 patients with 'eosinophilic synovitis'. In these patients, all below the age of 20 years with an acute onset of severe pain in the knee, there was a large effusion with painful limitation of movement. Their blood leucocyte count averaged 11,200 per mm3 with a mild eosinophilia of 6%. Biochemical examination of synovial fluid was normal, but cytology showed an increase in leucocytes ranging from 1200 to 20,500 (mean 9525) with between 75% and 90% of eosinophils in eight patients and 60% to 75% in four. All the patients responded well to a course of diethylcarbamazine.