Hooker JA, Lachiewicz PF, Kelley SS.
Efficacy of prophylaxis against thromboembolism with intermittent pneumatic
compression after primary and revision total hip arthroplasty.
J Bone Joint Surg Am 1999 May;81(5):690-6

Department of Orthopaedics, University of North Carolina, Chapel Hill 27599-7055, USA.

BACKGROUND: Thromboembolism is a common and important complication after total
hip arthroplasty. A variety of pharmacological and mechanical measures have been
proposed for prophylaxis. The purpose of the present study was to evaluate the
efficacy of intermittent pneumatic compression as prophylaxis against
thromboembolism following total hip arthroplasty. METHODS: The prospective study
involved a consecutive series of 425 patients in whom a total of 502 (324 primary
and 178 revision) total hip arthroplasties had been performed by two surgeons.
The patients were managed intraoperatively and postoperatively with use of
thigh-high elastic compression stockings and thigh-high intermittent pneumatic
compression sleeves. Experienced vascular technologists performed venous duplex
ultrasonography on both lower extremities of all patients at a mean of six days
(range, two to fifteen days) postoperatively. All patients were followed for at
least one year in order to detect late thromboembolism. RESULTS: An asymptomatic
deep-vein thrombosis was noted on the scans made after twenty-three (4.6 percent)
of the 502 procedures. Nineteen (3.8 percent) of the arthroplasties were followed
by the development of a proximal thrombosis and four (0.8 percent), a distal
thrombosis. Nineteen of the thromboses were ipsilateral (eighteen were proximal
and one, distal), and four were contralateral (one was proximal and three,
distal). No symptomatic deep-vein thrombosis developed in the hospital. In
addition, three (two proximal and one distal) symptomatic ipsilateral deep-vein
thromboses (a prevalence of 0.6 percent) developed three to twenty-three weeks
after postoperative scans revealed negative findings and the patients were
discharged from the hospital. Three symptomatic pulmonary embolisms (a prevalence
of 0.6 percent) were confirmed by ventilation-perfusion scanning while the
patients were in the hospital. There were no symptomatic pulmonary embolisms
after discharge, and there were no fatal pulmonary embolisms. With the numbers
available, we were unable to detect an association between deep-vein thrombosis
and age (p = 0.76), gender (p = 0.13), body-mass index (p = 0.12), type of
arthroplasty (primary or revision) (p = 0.12), operative approach (p = 0.37),
duration of the operation (p = 0.21), type of anesthesia (general or regional) (p
= 0.51), units of blood transfused (autologous, p = 0.79; homologous, p = 0.57),
blood type (p = 0.18), or the presence of a so-called classic risk factor for the
development of thrombosis (p = 0.22). Five arthroplasties (1.0 percent) were
followed by the development of a wound hematoma, but only one hematoma
necessitated operative drainage. CONCLUSIONS: The use of intraoperative and
postoperative thigh-high intermittent pneumatic compression, combined with duplex
ultrasonography performed by experienced vascular technologists, is effective for
prophylaxis against thromboembolism after both primary and revision total hip
arthroplasties. The low prevalence of deep-vein thrombosis (4.6 percent) and
symptomatic pulmonary embolism (0.6 percent) is comparable with that associated
with pharmacological prophylaxis.