Portable compression devices in total joint arthroplasty: poor outpatient compliance

Dietz, Matthew J.; Ray, Justin J.; Witten, Brent G.; Frye, Benjamin M.; Klein, Adam E.; Lindsey, Brock A.

doi:10.1016/j.artd.2019.12.004

Cited by 11 publications

(17 citation statements)

References 24 publications

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“…26 Interestingly, Dietz et al observed low rates of VTE (0.8%) in 115 TJA (50 THA and 65 TKA) patients despite poor compliance of portable IPCDs from postoperative day 1 (40 patients, 34.7%) to postoperative day 14 (17 patients, 14.8%) which may question the usefulness of continued mechanical prophylaxis once patients are fully ambulatory. 23 While our results showed no difference in periprosthetic fractures or dislocations between groups, these study findings support our institution's protocol change to discontinue outpatient IPCD use in patients undergoing THA. Prospective RCTs with a large sample size might more definitively address our study 1.5 Â 10 6 (0, -) 0 .…”

Section: Discussionsupporting

confidence: 69%

“…20,33 Dietz et al found no bleeding, wound, and infection complications in patients who were compliant with using their mobile IPCDs or not, although their study was not powered to detect a difference. 23 In our study, our results showed no difference in bleeding rates between the two groups (p ¼ 0.79). There was one case of bleeding seen in the control group (0.13%) due to hemorrhage from multiple gastric polyps and two cases (0.19%) in the no-IPCD group (one cases due to gastric ulcer and the other due to rectal bleeding).…”

Section: Discussioncontrasting

confidence: 43%

“…Our findings may provide useful information for patients who may have difficulty complying with portable outpatient IPCD use, in patients who may be at unnecessary risk for falls or skin tears, or for patients who may not be able to afford them. [23][24][25][26] McAsey et al evaluated mobile IPCD use in 247 THA patients maintained on 325-mg ASA BID and determined that 63.6% found these devices cumbersome while 10.1% reported having a fall while using the device. 25 Yeroushalmi et al studied 424 TJA patients (269 THA) discharged with home IPCDs and found that patients were significantly dissatisfied with their IPCDs and that these patients also experienced a significant number of trips or falls using the device.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 However, portable IPCD use may be associated with poor compliance, skin tears, falls, decreased patient satisfaction, and may be cost prohibitive for patients who cannot afford to pay for them either out-of-pocket or from insurance companies that may not be willing to pay. [23][24][25][26] Several studies have demonstrated the efficacy of multimodal approaches to VTE prophylaxis that include outpatient use of mobile IPCDs and ASA chemoprophylaxis. [20][21][22]27 Other studies have shown the efficacy of low-dose (81 mg) ASA alone for VTE prophylaxis.…”

mentioning

confidence: 99%

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Low-Dose Aspirin Thromboprophylaxis Is Safe and Effective in Patients Undergoing Total Hip Arthroplasty with or without Outpatient Pneumatic Compression Devices

Tang

Lygrisse

Zak

et al. 2021

The Journal of Hip Surgery

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Venous thromboembolism (VTE) remains a serious complication following total hip arthroplasty (THA). Current guidelines recommend pharmacologic prophylaxis with or without intermittent pneumatic compression devices (IPCDs). At our institution, portable IPCDs were previously worn by THA patients at standard risk for VTE for 14 days. Routine prescription of portable outpatient IPCDs was discontinued due to concerns with their efficacy and safety. We sought to determine if discontinuation of portable outpatient IPCDs changed VTE rates after THA. A retrospective review of 1,825 consecutive THA cases was conducted identifying patients with VTE, periprosthetic fractures, dislocations, bleeding complications, infection, and death at 90 days postoperatively. Patients were divided into two cohorts. One cohort received outpatient IPCDs for a period of 14 days (control) while the other did not (no-IPCD). All patients received inpatient IPCDs and were maintained on 81-mg aspirin (ASA) twice daily for 28 days. A total of 748 IPCD patients and 1,077 no-IPCD patients were identified. There was no difference between the total VTE rate for the IPCD versus no-IPCD groups (0 vs. 0.19%, p = 0.24). There were also no differences in periprosthetic fractures (p = 0.09), dislocations (p = 0.22), bleeding complications (p = 0.79), or infection rates (p = 0.75). No deaths were observed. The use of a low-dose ASA thromboprophylaxis protocol was safe and effective for VTE prevention in standard-risk patients undergoing THA with or without portable IPCDs. Any marginal benefit of portable IPCD use was too small to demonstrate despite our relatively large sample size.

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Section: Discussionsupporting

confidence: 69%

Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Low-Dose Aspirin Thromboprophylaxis Is Safe and Effective in Patients Undergoing Total Hip Arthroplasty with or without Outpatient Pneumatic Compression Devices

Tang

Lygrisse

Zak

et al. 2021

The Journal of Hip Surgery

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“…Since the publication of these two guideline reports, there have been 12 original studies evaluating various compression devices used from one day to three months postoperatively. Due to the large range, there appears to be no compelling evidence to suggest an optimal duration of mechanical compression amidst the current era of short-stay hospitalizations 453,458 .…”

Section: - Should Mechanical Compressive Devices Be Used Routinely In...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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