Haemodynamic performance of neuromuscular electrical stimulation (NMES) during recovery from total hip arthroplasty

Abstract

BackgroundPatients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery have yet to be established.MethodsThe popliteal veins of 11 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour neuromuscular electrical stimulation (NMES) session of the calf muscles. The effect of calf muscle NMES on peak venous velocity, mean venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn.ResultsIn the operated limb NMES produced increases in peak venous velocity of 99% compared to resting. Mean velocity increased by 178% compared to resting and volume flow increased by 159% compared to resting. In the un-operated limb, peak venous velocity increased by 288%, mean velocity increased by 354% and volume flow increased by 614% compared to basal flow (p<0.05 in all cases). There were no significant differences observed between the VAS scores taken before the application of NMES, once NMES was initiated and before NMES was withdrawn (p=.211).ConclusionsNMES produces a beneficial hemodynamic response in patients in the early post-operative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable.Trial registrationClinicalTrials.gov NCT01785251

Neuromuscular electrical stimulation for thromboprophylaxis: A systematic review

“…In Warwick et al, 35 the geko device was active for 5 min in each position and the median VAS score and VRS across all positions were 2.5 and 2, respectively. Consistent with these, Broderick et al 36 reported that the mean VAS score at start and end of 4 h electrical stimulation were 2.3 and 3.6, respectively. In Broderick et al, 40 the mean VAS score after 2 h and 4 h of stimulation were 2.7 and 2.8, respectively.…”

“…However, the incidence of DVT in patients with malignant disease was significantly lower Williams et al 23 Geko T-1 1 70-560 ms 2 7 N R Izumi et al 24 SEN-52901 10 NR NR 100 Jawad et al 25 Geko T-1 1 70-560 ms 2 7 N R Warwick et al 35 Geko T-1 1 0-400 ms 2 7 N R Broderick et al 36 Duo Williams et al 23 Izumi et al 24 Jawad et al 25 Goyal et al 26 Velmahos et al 27 Merli et al 29 Bostrom et al 30 Lindströ m et al 28 Doran et al 31 Doran and White 32…”

“…Jawad et al 25 demonstrated 32% and 4.5% increase in mean venous volume flow at normal clinical setting and at threshold setting, respectively. In Broderick et al, 36 NMES resulted in 159% increase in venous volume flow in the operated limb and 614% increase in non-operated limb. All methods of calf-muscle stimulation in Izumi et al 39 resulted in >2.5 times increase in flow compared with baseline.…”

“…In Broderick et al, 36 NMES increased the peak venous velocity in operated and non-operated limbs by 99% and 288%, respectively. Also, it increased the mean venous velocity in operated and non-operated legs by 178% and 354%, respectively.…”

Hemodynamic effects of electrical muscle stimulation in the prophylaxis of deep vein thrombosis for intensive care unit patients: a randomized trial

“…Thus, we hypothesized that attaching EMS on the lower limbs might have a potential to produce a similar effect of exercise therapy even for the patients forced to be immobile for prolonged periods. Some reports suggest that EMS may have a preventive effect on DVT not only in healthy subjects [8] but also in total knee/hip arthroplasty patients [11, 12] and postoperative patients [13]. However, a report on EMS use in patients with major trauma failed to show a significant difference in the rate of DVT formation and venous flow parameters between the patients with and without EMS [14].…”