Woolson ST.
Intermittent pneumatic compression prophylaxis proximal deep venous thrombosis
after total hip replacement.
J Bone Joint Surg Am 1996 Nov;78(11):1735-40

Stanford University Hospital, California, USA.

The efficacy of intermittent pneumatic compression in the prevention of proximal
deep venous thrombosis was determined in a consecutive series of patients who had
primary or revision total hip replacement. Two hundred and eighty-nine patients
(242 primary and eighty revision hip replacements) who were at least forty years
old were managed intraoperatively and postoperatively with intermittent pneumatic
compression with use of thigh-high sequential compression sleeves and thigh-high
elastic compression stockings as the only form of prophylaxis. Venous
ultrasonography of the ipsilateral lower extremity was performed, at an average
of five days postoperatively, to determine the presence of a thrombus in the
femoral and popliteal veins. The prevalence of proximal deep venous thrombosis
was 6 per cent (twenty of 322 procedures), and no patient had a clinically
detected pulmonary embolism. The prevalence of a proximal thrombus was 4 per cent
(ten of 233 procedures) when a regional anesthetic had been used and 11 per cent
(ten of eighty-nine procedures) when a general anesthetic had been used; this
difference was significant (p = 0.02). The prevalence of a proximal thrombus was
3 per cent (eight of 245 procedures) for patients who were less than seventy-five
years old and 16 per cent (twelve of seventy-seven procedures) for patients who
were seventy-five years old or more (p < 0.0001). No patient had a major bleeding
complication. Twenty-nine other patients who had an additional risk factor for
thrombosis, such as a history of deep venous thrombosis, were managed with
intermittent pneumatic compression and low-dose warfarin. The prevalence of
proximal deep venous thrombosis in this group of patients was 19 per cent (six of
thirty-one procedures). Intraoperative and postoperative intermittent pneumatic
compression, combined with the use of a regional anesthetic, was found to be
highly effective in the prevention of proximal deep venous thrombosis after total
hip replacement. Despite the limitations inherent in comparisons among series, it
is noteworthy that the prevalence of proximal thrombosis in our series was
similar to the reported prevalences in several large series of patients who had a
total hip replacement and were managed with either low-dose warfarin or
low-molecular-weight heparin. However, there was no risk of major postoperative
bleeding in the current study.