Tamir L, Hendel D, Neyman C, Eshkenazi AU, Ben-Zvi Y, Zomer R.
Sequential foot compression reduces lower limb swelling and pain after total knee
arthroplasty.
J Arthroplasty 1999 Apr;14(3):333-8

Orthopedic Department Rabin Medical Center, Petach Tikva, Israel.

Two common prophylactic measures to prevent deep vein thrombosis (DVT) in
patients after orthopedic lower limb surgeries are pneumatic foot and calf
compression and antithrombotic treatment. These preventive measures differ in
their mechanisms of operation. Antithrombotic agents are aimed to minimize the
risk of clot formation, whereas pneumatic foot and calf compression therapy
prevents venous stasis, which is a primary factor leading to thrombus formation
in patients with leg trauma. DVT, however, is not the only consequence of patient
immobility and venous stasis. Additional sequelae of venous stasis include lower
limb swelling and pain resulting from the increase in venous pressures and change
of normal compartmental circulatory pressures. We therefore hypothesized in the
present study that antithrombotic treatment alone is not as effective as combined
with pneumatic foot compression in reducing limb swelling and pain. Forty-eight
patients after total knee arthroplasty participated in this randomized,
controlled study. Low-molecular-weight heparin was the prophylactic measure used
for the control group, whereas the pneumatic compression group received
low-molecular-weight heparin and foot compression therapy for approximately 7
days after surgery. Lower limb swelling and pain were significantly reduced for
the foot compression group in relation to the control group. Ultrasound and
venography demonstrated no significant DVT in either group. We conclude that foot
compression therapy is an important prophylactic addition to antithrombotic
treatment in overcoming the hazardous clinical implications of venous stasis.