Westrich GH, Menezes A, Sharrock N, Sculco TP.
Thromboembolic disease prophylaxis in total knee arthroplasty using
intraoperative heparin and postoperative pneumatic foot compression.
J Arthroplasty 1999 Sep;14(6):651-6

Hospital for Special Surgery-Cornell University Medical Center, New York, New York 10021, USA.

A prospective study was performed to assess the clinical efficacy of
intraoperative heparin combined with postoperative pneumatic foot compression and
aspirin for thromboembolic disease prophylaxis after primary total knee
arthroplasty (TKA). This group of 48 patients all had a primary TKA performed
under epidural anesthesia. The cohort of patients was compared with a similar
cohort of patients matched for age and comorbidity. The control group consisted
of 61 patients (41 unilateral patients, 20 bilateral patients) with 81 TKAs who
received epidural anesthesia and postoperative pneumatic foot compression and
aspirin. The same surgeon and anesthesiologist performed all cases. All patients
had the pneumatic foot compression device applied in the recovery room and
received 325 mg of enteric-coated aspirin twice a day beginning the night of
surgery. Venography was performed on the fifth postoperative day for both groups
to determine the incidence of deep vein thrombosis (DVT). In the control group
with postoperative pneumatic foot compression (group 1), the overall incidence of
DVT was 27% (22 of 81), with 10% (8 of 81) major calf DVT and no proximal
(popliteal or femoral) DVT. In the study group with intraoperative heparin and
postoperative pneumatic foot compression (group 2), the overall incidence of DVT
was 25% (12 of 48), with 8% (4 of 48) major calf DVT and no proximal DVT. There
was no statistically significant difference between groups 1 and 2 for the
incidence of overall DVT (P > .05) or major calf DVT (P > .05). No complications
were associated with the use of intraoperative heparin or the pneumatic
compression device, and no patient developed a symptomatic pulmonary embolism up
to 3 months postoperatively. Although this study confirms that pneumatic foot
compression combined with aspirin is an effective form of DVT prophylaxis after
TKA, the added benefit of intraoperative heparin was not statistically proven.
Although greater statistical power is needed to determine whether intraoperative
heparin provides an added benefit, this study reveals a low incidence of DVT in
TKA with this protocol.