TREATMENT OF FIXED FLEXION DEFORMITIES OF THE KNEE IN RHEUMATOID ARTHRITIS USING THE FLOWTRON INTERMITTENT COMPRESSION STOCKING

Thirty established fixed flexion deformities of the knee in18 rheumatoid arthritis patients were studied prospectivelyto assess the results of 8 weeks of out-patient treatment usingthe Flowtron intermittent compression stocking. A 44% mean correction of the fixed flexion deformity was obtainedfrom an initial mean of 29±1° to 16±1°(P<0.001). More than 85% of this correction was obtainedin the first 4 weeks of treatment. There was a significant correlationbetween the correction obtained and the inflation pressure (P<0.05),but the time of daily use (minimum 60 min) was not a significantfactor. The modified Stanford Health Assessment Disability Indexfell from an initial mean of 2.17 to 2.03 (P<0.01). KEY WORDS: Fixed flexion deformity, Knee, Rheumatoid arthritis     

SIX-YEAR FOLLOW-UP OF MULTIPLE JOINT REPLACEMENT SURGERY TO THE LOWER LIMBS

We report a 6-yr follow-up study of an original population of50 patients who had three or more major joints (hips and knees)replaced. Thirty-one of 32 surviving patients were still ambulantin the community, and all patients described significant painrelief. No RA patient was requiring permanent inpatient or residentialcare and the family remained the main social support. They remaineda very disabled group with a median Health Assessment Questionnairescore of 2.75. Ten required revision surgery: three hips andseven knees; four patients required their fourth lower limbjoint (hip/knee) replaced and seven patients required surgeryto the upper limbs and nine feet during the follow-up period.The median 10-yr survival of hip and knee arthroplasties inmultiple joint replacement (MJR) patients with RA was 90.5 and78.6% respectively. There was an increased incidence of cervicalmyelopathy in MJR patients 16.9%. The mortality rate was higherthan expected (standardized mortality ratio = 590) but the actualsurgery was not implicated. MJR therefore appears to be a worthwhilepolicy, even at long-term follow-up. KEY WORDS: Multiple joint replacement, Rheumatic arthritis, Cervical myelopathy     

COMPARATIVE STUDY OF IBUPROFEN AND ASPIRIN IN SOFT-TISSUE INJURIES

A double-blind trial of ibuprofen (Brufen) and aspirin was carriedout in 60 soft-tissue injuries to the lower limb in a smallgroup of rigorously supervised professional footballers. Ibuprofensignificantly reduced the period and severity of pain (p<0.01)and allowed training on average two days earlier than the controlstaking aspirin (p<0.001). Players were also able to reachmatch fitness earlier with ibuprofen (p<0.01). The possibleaction and use of anti-inflammatory agents given immediatelyafter soft-tissue trauma are discussed.     

ATHLETIC INJURIES

An indication of the scope of an athletes' clinic run withina Department of Physical Medicine and Rheumatology is given,based on 150 consecutive sports injuries seen. The importanceof overuse injuries in relation to present training methodsis stressed.