Pneumatic compression with foot pumps facilitates early postoperative mobilisation in total knee arthroplasty

Abstract

Deep-vein thrombosis (DVT) and pulmonary embolism (PE) represent life-threatening postoperative complications frequently responsible for in-hospital mortality following total knee arthroplasty (TKA). Mechanical prophylaxis in the form of a foot pump offers an alternative to pharmacological and physical therapy. The aim of this prospective and randomised study was to examine the clinical efficacy of the A-V Impulse (AVI) system in reduction of soft-tissue swelling of the lower limb following a TKA. A total of 80 patients undergoing cemented TKA between September 2005 and December 2006 were randomised into two groups of 40 patients (n¹ = 40, n² = 40) during the 16-month study period. All patients received a subcutaneous dose of low molecular weight heparin (LMWH) (Enoxaparin/Clexane® 40 mg) once daily beginning 24 hours prior to the operation. The mean age for the groups n¹ and n² were 68.93 and 68.15 years, respectively. The reduction of soft-tissue swelling in the n¹ group was significantly higher (p < 0.05) compared with n². Evaluation of body mass index (BMI) with regard to the average reduction of soft-tissue swelling showed no significant influence (p < 0.05). The better function of the operated knee in group AVI was a significant predictor for improved agility and mobility (p < 0.01). No complications were reported for the application of the AVI. No ultrasonographic evidence of DVT or PE was found in any of the 80 patients during the investigative time period of eight days. After three months, there was no evidence of a symptomatic DVT.

Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis

“…Of these, 6 were observational studies [29][30][31][32][33][34] and 41 were RCTs. Twenty-one studies included patients undergoing hip arthroplasty, 20 included those undergoing knee arthroplasty, 29,30,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72]75 and 6 included both. [31][32][33][34]73,74 More than 1 prophylactic drug was used in several studies (eg, case group using pentassacharide and control group using enoxaparin).…”

“…The 47 studies recruited 44 844 patients (21 369 undergoing TPHA and 23 475 undergoing TPKA). eTables 2-4 summarize, respectively, the characteristics of the 21 TPHA studies, the 20 TPKA studies, 29,30,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72]75 and the 6 studies for both TPHA and TPKA, [31][32][33][34]73,74 which reported 443 cases of symptomatic postoperative VTE that occurred between surgery and patient hospital discharge, 288 in the patients undergoing knee arthroplasty and 155 in those undergoing hip arthroplasty. Of these cases, 275 were DVT (182 in the TPKA group and 93 in the TPHA group) and 149 were pulmonary embolism (106 in the TPKA group and 43 in the TPHA group).…”

“…Of these cases, 275 were DVT (182 in the TPKA group and 93 in the TPHA group) and 149 were pulmonary embolism (106 in the TPKA group and 43 in the TPHA group). Symptomatic DVT was confirmed by means of ultrasonography, bilateral venography, or both in 32 studies (68%),* by duplex ultrasonography in 5 studies (11%), [29][30][31]43,56 and by one of these in 10 studies (21%). † Pulmonary embolism was confirmed by one of the following methods in all studies: lung ventilation/perfusion scintigraphy, spiral computed tomography, pulmonary angiography, or autopsy in patients who died.…”

Kinesiotaping for postoperative oedema – what is the evidence? A systematic review

“…Considering extremity surgery, manual lymphatic drainage is broadly accepted for the treatment of postoperative and posttraumatic oedema [31][32][33] as well as oedema caused by other pathologies [2,29,30], even though corresponding evidence is conflicting [3,4,34,35]. The application of pneumatic compression was also established as treatment option [36][37][38], although again with limited evidence base [38][39][40][41]. Kinesiotaping might be yet another approach for the treatment of oedema.…”

A Current Review of Mechanical Compression and Its Role in Venous Thromboembolic Prophylaxis in Total Knee and Total Hip Arthroplasty

“…Conversely, studies have shown no differences in VTE rates when foot pumps were added compared to chemoprophylaxis alone, but this has only been reported following THA [54,[56][57][58][59]. A single institution prospective randomized clinical trial comparing foot pumps to LMWH found no difference in DVT incidence following THA at 6-day follow-up (18% versus 13%; P = 0.25) [54].…”