Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance

A comparative, prospective clinical trial
Original Paper

Abstract

Mechanical prophylaxis with foot pumps provides an interesting alternative to chemical agents in the prevention of thromboembolic disease following major orthopaedic surgical procedures. Recent studies have suggested that the simultaneous use of graduated compression stockings (GCS) may hinder the pneumatic compression effect of foot pumps. The hypothesis of this prospective study was that the use of foot pumps without GCS does not affect the efficacy of deep-vein thrombosis (DVT) prophylaxis and improves patient compliance. A total of 846 consecutive patients admitted at a single institution undergoing total hip (THR) or knee replacement (TKR) were included in the study. The A-V Impulse System foot-pump unit (Orthofix Vascular Novamedix, Andover, UK) was used in all patients. Of these 846 patients, 46 discontinued the use of foot pumps, leaving 400 patients who received foot pumps in combination with GCS and 400 patients with foot pumps alone. Eleven patients of the stocking group (2.7%) and nine patients of the no-stocking group (2.3%) developed postoperative symptomatic DVT (p = 0.07). DVT was more frequent in TKR (10/364; 2.7%) than in THR (10/436; 2.3%). Non-fatal pulmonary embolism occurred in four of the 20 patients with symptomatic DVT, two patients each of the stocking and no-stocking groups. The foot-pump discontinuation rate of patients treated with stockings was 7% versus 4% of the patients treated without stockings (p < 0.05). In conclusion, management of patients with foot pumps without GCS does not reduce the efficacy of DVT prophylaxis after THR and TKR and improves patient compliance.

Résumé

La prophylaxie des complications thrombo-emboliques par « pompage » pédieux est une alternative au traitement médical en chirurgie orthopédique. Une étude récente a montré que l’utilisation simultanée de bas à compression élastique et de compression pneumatique au niveau du pied peut cacher l’effet de cette dernière technique. L’hypothèse émise pour ce travail prospectif est la suivante, l’utilisation de pompes au niveau des pieds sans bas de contention élastique n’entraîne pas de complications thrombo-emboliques complémentaires. 846 patients ayant bénéficié d’une prothèse totale de hanche et du genou ont été inclus dans cette étude. Le système utilisé a été le AV impluse système foot pump units de Orthofix Vascular Novamedix, Andover. 46 patients ont bénéficié de la pompe en discontinue, 400 patients ont utilisé la pompe en combinaison avec les bas de contention et 400 patients la pompe uniquement.11 patients du groupe contention élastique (2,7%) et 9 patients du groupe sans contention (2,3%) ont présenté en post-opératoire une complication thrombo embolique (p = 0.07). Les complications de type thrombose veineuse profonde sont plus fréquentes dans la prothèse du genou (10 sur 364 ; 2.7%) que dans la prothèse de hanche (10 sur 436 ; 2,3%). 4 embolies pulmonaires n’ayant entraîné aucun décès sont survenues sur un groupe de 20 patients ayant présenté une thrombose veineuse symptomatique, 2 dans le groupe bas de contention et deux dans le groupe sans bas de contention. Le système de pompe, au niveau du pied en discontinue associé à des bas de contention élastiques a été de 7% en comparaison de patients traités sans contention 4% (p < 0.05). En conclusion, l’utilisation d’un système de pompe au niveau du pied sans bas de contention élastique ne réduit pas l’efficacité de la prophylaxie du traitement des complications thrombo-emboliques de la prothèse totale de hanche dans la prothèse totale du genou et améliore le confort des patients.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical SchoolUniversity of AucklandAucklandNew Zealand

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