Graded Compression Stockings for Prevention of Deep-Vein Thrombosis After Hip and Knee Replacement

Abstract

We performed a prospective, randomised controlled trial in 177 patients who were having either total hip or knee replacement, to evaluate the use of both above-and below-knee graded compression stockings in the prevention of deep-vein thrombosis (DVT).With above-knee stockings, we found no significant reduction of the overall, proximal or major calf (> 5 cm) DVT rates. With below-knee stockings, the overall thrombosis rate was similar to that of the control group but the stockings appeared to have altered the pattern of thrombosis. Patients who had total hip replacement and wore below-knee stockings had a significantly higher rate of proximal or major calf DVT (p = 0.03). This pattern was reversed in patients with total knee replacement who developed a significantly lower rate of proximal or major calf DVT with below-knee stockings (p < 0.05).Our results showed that, with the exception of below-knee stockings in knee replacement patients, graded compression stockings were ineffective in preventing DVT after hip or knee replacement surgery.

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

“…The between-study variance was also compared with the between-study variance estimated for the nine trials that provided estimates for the effectiveness of thigh-length stockings versus no stockings using the Mantel-Haenszel method. 22,24,25,30,33,[35][36][37]49 Model convergence was evaluated by reviewing the posterior densities of the model parameters and the Ruben-Gelman statistic. 50 In total, 20,000 iterations were discarded and the results were based on a further 50,000 iterations.…”

“…Eight RCTs compared GCSs alone with no stockings; the incidence of DVT was statistically significantly lower in the stocking group than in the no stockings group. [22][23][24][25][26][27][28][29] Ten RCTs compared GCSs plus another prophylactic method versus the prophylactic method alone; the incidence of DVT was statistically significantly lower in the stocking plus other prophylactic method group than in the other prophylactic alone group. [30][31][32][33][34][35][36][37][38][39] The authors concluded that GCSs are effective at diminishing the risk of DVT in hospitalised patients.…”

“…12,[20][21][22][23][24][25][30][31][32][33][34][35][36][37]49,[60][61][62][63][64][65][66] Of these 23 RCTs, 21 reported data for the outcome DVT. 12,[20][21][22][23][24][25][30][31][32][33][34][35][36][37]49,60,61,63,65,66 However, one trial did not report sufficient data to be included in the meta-analysis or NMA, as total numbers of patients in treatment groups were not reported. 65 An additional seven trials did not add to the network of evidence comparing thigh-length with knee-length GCSs.…”

“…23,31,32,34,61,63,66 Therefore, 13 RCTs contained data that directly or indirectly informed the relative effectiveness of thigh-length versus knee-length stockings and were included in the NMA. 12,[20][21][22]24,25,30,33,[35][36][37]49,60 Figure 2 presents the flow of studies through the study selection process. Details of studies excluded at the full publication stage, with the reason for their exclusion, are provided in Appendix 2.…”

Thromboseprophylaxe in der muskuloskelettalen Chirurgie

“…Die Studie hatte drei Arme, die einmal täglich entweder 220 mg eindeutigen Vorteil für Kompressionsstrümpfe als VTEProphylaxe [16]. Studien mit Patienten nach Schlaganfall zeigten einen numerischen, aber nicht statistisch signifikanten Vorteil für Kompressionsstrümpfe in der Verhinderung von VTE, bei gleichzeitigem starken Ansteigen von Hautkomplikationen [17,18].…”