Graded compression stockings in elective orthopaedic surgery

Abstract

We recruited 89 patients who had hip or knee replacements to assess the performance of below-knee graded compression stockings. The pressure gradients generated by the stockings were measured and all patients had venography of the ipsilateral leg.We found that 98% of stockings failed to produce the 'ideal' pressure gradient (± 20%) of 18, 14 and 8 mmHg from the ankle to the knee, while 54% produced a 'reversed gradient' on at least one occasion during the course of the study. The overall rate of deep-venous thrombosis was 16.7%. Stockings which produced reversed gradients were associated with a significantly higher incidence of deep-venous thrombosis (p = 0.026) than those with the correct gradient (25.6% v 6.1%). This suggests that the performance of graded compression stockings can be improved if reversed pressure gradients are detected and prevented.

Resting Pressure Exerted by Round Knitted Moderate-Compression Stockings on the Lower Leg in Clinical Practice—Results of an Experimental Study

“…On the one hand, insufficient interface pressures could result in inadequate treatment of chronic venous insufficiency and consequent delayed improvement or lack of improvement in symptoms of chronic venous insufficiency such as edema, eczema, hyperpigmentation, and ulceration. On the other hand, excessive ankle interface pressures could cause skin necrosis and thrombosis 7–9 …”

“…As a result of a poorly fitting compression bandage or stocking, nerve lesions, blistering, erosions, and even ulceration can prolong or complicate an existing venous condition 7,8 . Band‐like constrictions due to compression therapy can increase the risk of deep vein thrombosis 9 …”

Venous thromboembolism prevention – an update

“…However, Best et al (2000) found that 98% of stockings failed to produce the 'ideal' pressure gradient of 18, 14 and 8 mmHg from the ankle to the knee, while 54% produced a 'reversed gradient' on at least one occasion. …”