Westrich GH, Specht LM, Sharrock NE, Windsor RE,
Sculco TP, Haas SB, Trombley JF, Peterson M.
Venous haemodynamics after total knee arthroplasty: evaluation of active dorsal
to plantar flexion and several mechanical compression devices.
J Bone Joint Surg Br 1998 Nov;80(6):1057-66

The Hospital for Special Surgery, New York, NY 10021, USA.

We performed a crossover study to evaluate the haemodynamic effect of active
dorsal to plantar flexion and seven pneumatic compression devices in ten patients
who had a total knee arthroplasty. Using the Acuson 128XP/10 duplex ultrasound
unit with a 5MHz linear array probe, we assessed the augmentation of peak venous
velocity and venous volume above and below the junction of the greater saphenous
and common femoral veins in order to study both the deep and superficial venous
systems. The pneumatic compression devices evaluated included two foot pumps (A-V
Impulse System and PlexiPulse Foot), a foot-calf pump (PlexiPulse Foot-Calf), a
calf pump (VenaFlow System) and three calf-thigh pumps (SCD System, Flowtron DVT
and Jobst Athrombic Pump). The devices differed in a number of ways, including
the length and location of the sleeve and bladder, the frequency and duration of
activation, the rate of pressure rise, and the maximum pressure achieved. A
randomisation table was used to determine the order of the test conditions for
each patient. The enhancement of peak venous velocity occurred primarily in the
deep venous system below the level of the saphenofemoral junction. The increases
in peak venous velocity were as follows: active dorsal to plantar flexion 175%;
foot pumps, A-V Impulse System 29% and PlexiPulse 65%; foot-calf pump,
PlexiPulse, 221%; calf pump, VenaFlow, 302% and calf-thigh pumps, Flowtron DVT
87%, SCD System 116% and Jobst Athrombic Pump 263%. All the devices augmented
venous volume, the greatest effect being seen with those incorporating calf
compression. The increases in ml/min were found in the deep venous system as
follows: foot pumps, A-V Impulse System 9.6 and PlexiPulse Foot 16.7; foot-calf
pump, PlexiPulse, 38.1; calf pump, VenaFlow, 26.2; calf-thigh pumps, Flowtron DVT
61.5, SCD System 34.7 and Jobst Athrombic Pump 82.3. Active dorsal to plantar
flexion generated 8.5 ml for a single calf contraction.