ROLE OF FLOWTRON IN IMPROVING FIXED FLEXION DEFORMITY PRIOR TO TKR.

Abstract

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.