International Orthopaedics

, Volume 35, Issue 7, pp 995–1000 | Cite as

Pneumatic compression with foot pumps facilitates early postoperative mobilisation in total knee arthroplasty

  • C. Windisch
  • W. Kolb
  • K. Kolb
  • P. Grützner
  • R. Venbrocks
  • J. Anders
Original Paper

Abstract

Deep-vein thrombosis (DVT) and pulmonary embolism (PE) represent life-threatening postoperative complications frequently responsible for in-hospital mortality following total knee arthroplasty (TKA). Mechanical prophylaxis in the form of a foot pump offers an alternative to pharmacological and physical therapy. The aim of this prospective and randomised study was to examine the clinical efficacy of the A-V Impulse (AVI) system in reduction of soft-tissue swelling of the lower limb following a TKA. A total of 80 patients undergoing cemented TKA between September 2005 and December 2006 were randomised into two groups of 40 patients (n¹ = 40, n² = 40) during the 16-month study period. All patients received a subcutaneous dose of low molecular weight heparin (LMWH) (Enoxaparin/Clexane® 40 mg) once daily beginning 24 hours prior to the operation. The mean age for the groups n¹ and n² were 68.93 and 68.15 years, respectively. The reduction of soft-tissue swelling in the n¹ group was significantly higher (p < 0.05) compared with n². Evaluation of body mass index (BMI) with regard to the average reduction of soft-tissue swelling showed no significant influence (p < 0.05). The better function of the operated knee in group AVI was a significant predictor for improved agility and mobility (p < 0.01). No complications were reported for the application of the AVI. No ultrasonographic evidence of DVT or PE was found in any of the 80 patients during the investigative time period of eight days. After three months, there was no evidence of a symptomatic DVT.

References

  1. 1.
    Asano H, Matsubara M, Suzuki K et al (2001) Prevention of pulmonary embolism by a foot sole pump. J Bone Joint Surg Br 83:1130–1132PubMedCrossRefGoogle Scholar
  2. 2.
    Colwell CW Jr, Froimson MI, Mont MA, Ritter MA, Trousdale RT, Buehler KC, Spitzer A, Donaldson TK, Padgett DE (2010) Thombosis prevention after total hip Arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. J Bone Joint Surg Am 92:527–535PubMedCrossRefGoogle Scholar
  3. 3.
    Eisele R, Kinzl L, Koelsch T (2007) Rapid-inflation intermittent pneumatic compression for prevention of deep venous thrombosis. J Bone Joint Surg Am 89:1050–1056PubMedCrossRefGoogle Scholar
  4. 4.
    Fitzgerald RH Jr, Spiro TE, Trowbridge AA, Gardiner GA Jr, Whitsett TL, O’Connell MB, Ohar JA, Young TR (2001) Prevention of venous thromboembolic disease following primary total knee arthroplasty. A randomized, multicenter, open-label, parallel-group comparison of enoxaparin and warfarin. J Bone Joint Surg Am 83:900–906PubMedGoogle Scholar
  5. 5.
    Gardner AM, Fox RH (1983) The venous pump of the human foot: preliminary report. Bristol Med Chir J 98:109–112PubMedGoogle Scholar
  6. 6.
    Gardner AM, Fox RH, Lawrence C, Bunker TD, Ling RS, MacEachern AG (1990) Reduction of post-traumatic swelling and compartement pressure by impulse compression of the foot. J Bone Joint Surg Br 72:810–815PubMedGoogle Scholar
  7. 7.
    Grady-Benson JC, Oishi CS, Hannson PB et al (1994) Postoperative surveillance for deep venous thrombosis with duplex ultrasound after total knee arthroplasty. J Bone Joint Surg Am 76A:1649–1657Google Scholar
  8. 8.
    Haas S (2004) Thrombosis in trauma and orthopedic surgery. Prevention, diagnosis, therapy. Unfallchirurg 100(4):307–319Google Scholar
  9. 9.
    Higgs D, Uglow M, Fail T (2004) Graduated compression stockings reduce the venous velocity augmentation of foot pumps. J R Nav Med Serv 90:142–146PubMedGoogle Scholar
  10. 10.
    Hooker JA, Lachiewicz PF, Kelley SS (1999) Efficacy of prophylaxis against thromboembolism with intermittend pneumatic compression after primary and revision total hip arthroplasty. J Bone Joint Surg Am 81:690–696PubMedGoogle Scholar
  11. 11.
    Ivanic G, Moser I, Homann NC et al (2006) Die intermittierende Impulskompression zur Abschwellung und Thromboseprophylaxe – Pilotstudie nach Hüft-TEP: Ist die Minimalanwendungsdauer von 2 h täglich ausreichend? Unfallchirurg 109(9):786–792PubMedCrossRefGoogle Scholar
  12. 12.
    Kraay MJ, Goldberg VM, Herbener TE (1993) Vascular ultrasonography for deep venous ultrasonography for deep venous thrombosis after total knee arthroplasty. Clin Orthop 286:18–26PubMedGoogle Scholar
  13. 13.
    Lachiewicz PF, Kelley SS, Haden RN (2004) Two mechanical devices for prophylaxis of thromboembolism after total knee arthroplasty. Aprospective, randomised study. J Bone Joint Surg Br 86:1137–1141PubMedCrossRefGoogle Scholar
  14. 14.
    Maynard MJ, Sculco TP, Ghelman B (1991) Progression and regression of deep venous thrombosis after total knee arthroplasty. Clin Orthop 273:125–130PubMedGoogle Scholar
  15. 15.
    Pitto RP, Young S (2008) Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safty and patient compliance. Int Orthop 32:331–336PubMedCrossRefGoogle Scholar
  16. 16.
    Pitto RR, Hamer H, Heiss-Dunlop W et al (2004) Mechanical prophylaxis of deep-vein thrombosis after total hip replacement: a randomised clinical trial. J Bone Joint Surg Br 86:639–642PubMedCrossRefGoogle Scholar
  17. 17.
    Santori FS, Vitullo A, Stopponi M et al (1994) Prophylaxis against deep-vein thrombosis in total hip replacement: comparison of heparin and foot impulse pump. J Bone Joint Surg Br 76:579–583PubMedGoogle Scholar
  18. 18.
    Stannard JP, Lopez-Ben RR, Volgas DA, Aderson ER, Busee M, Karr DK, GR McGwin JR, Alonso JE (2006) Prophylaxis against deep-vein thrombosis following trauma: a prospective, randomized comparison of mechanical and Pharmacologic prophylaxis. J Bone Joint Surg Am 88:261–266PubMedCrossRefGoogle Scholar
  19. 19.
    Stöckle U, Hoffmann R, Raschke M et al (1996) Intermittierende Impulskompression – die alternative in der therapie des posttraumatischen und postoperativen Ödems. Chirurg 67:539–545PubMedGoogle Scholar
  20. 20.
    Warwick DJ, Hertmant P, Shewale S, Sulkin T (2002) Venous impulse foot pumps. Should graduated compression stockings be used? J Arthroplasty 17:446–448PubMedCrossRefGoogle Scholar
  21. 21.
    Warwick D, Harrison J, Glew D et al (1998) Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep- vein thrombosis after total hip replacement. J Bone Joint Surg Am 80:1158–1166PubMedGoogle Scholar
  22. 22.
    Westrich GH, Haas SB, Mosca P, Peterson M (2000) Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty. J Bone Joint Surg Br 82:795–800PubMedCrossRefGoogle Scholar
  23. 23.
    Westrich GH, Specht LM, Sharrock NE et al (1998) Venous heamodynamics after total knee arthroplasty: evaluation of active dorsal to plantar flexion and several mechanical compression devices. J Bone Joint Surg Br 80:1057–1066PubMedCrossRefGoogle Scholar
  24. 24.
    Westrich GH, Sculco TP P (1996) Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg Am 78:826–834PubMedGoogle Scholar
  25. 25.
    Wilson NV, Das SK, Kakkar VV et al (1992) Thrombo-embolic prophylaxis in total knee replacement. J Bone Joint Surg Br 74:50–52PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • C. Windisch
    • 1
  • W. Kolb
    • 2
  • K. Kolb
    • 3
  • P. Grützner
    • 3
  • R. Venbrocks
    • 1
  • J. Anders
    • 1
  1. 1.Department of Orthopaedic SurgeryFriedrich-Schiller-University Jena at Rudolf-Elle-Hospital EisenbergEisenbergGermany
  2. 2.Department of Trauma and Orthopaedic SurgeryBethesda HospitalStuttgartGermany
  3. 3.Department of Trauma SurgeryKatharinenhospitalStuttgartGermany

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