Thromboembolic Disease Prophylaxis in Orthopaedic Surgery: Use of Mechanical Compression Devices

Abstract

Due to the high incidence of deep venous thrombosis (DVT) following orthopaedic surgery, DVT prophylaxis is imperative. Because of the morbidity associated with these complications, it is essential to provide prophylaxis for DVT as well as pulmonary embolism. Currently there are various prophylactic modalities available to the clinician, involving both chemical and mechanical forms of treatment. Unlike, current forms of chemoprophylaxis, which are not without their associated side effects and costs, mechanical treatments have been shown to be both safe and effective. Previous studies have shown mechanical compression devices to be efficacious in reducing the rate of DVT after orthopaedic surgery. These compression devices vary according to the location of the sleeve and bladder, frequency and duration of activation rate, rate of pressure rise, maximum pressure achieved, and simultaneous versus sequential compression. Moreover, pneumatic compression devices are further categorized as foot pumps and calf-thigh pumps, of which some are single chamber whereas others are sequential chambers with a number of compartments. This chapter discusses the specifications of the mechanical devices in relation to their clinical efficacy as well as the effects on venous hemodynamics and physiology.

IVC Filters May Prevent Fatal Pulmonary Embolism in Musculoskeletal Tumor Surgery

“…Nevertheless, the use of intermittent pneumatic compression devices for DVT prophylaxis without anticoagulation is not without merit. In one meta-analysis [37], pneumatic compression effected the lowest rates of DVT after TKA compared with low-molecular-weight heparin, aspirin, and warfarin, resulting in a 17.5% rate of DVT and 6.3% rate of asymptomatic PE [38]. Our DVT rate is closer to that of Lin et al [22], who reported a 14.2% rate of proximal DVT in 169 patients with cancer undergoing major orthopaedic surgery and receiving mechanical prophylaxis.…”

“…Most patients undergoing resections and/or reconstructions for pelvic and lower extremity malignancies will have long postoperative recovery periods and will require extensive dissections around blood vessels of various calibers [3], with the risk of endothelial injury that can lead to thrombus formation and subsequent DVT. Although prophylaxis for DVT and PE have been described extensively for patients undergoing major orthopaedic procedures, such as hip fracture surgery and total joint arthroplasties [10,24,26,37,38], few have been described specifically for patients with musculoskeletal tumors [3,22,27,30].…”

Recommendations from the ICM-VTE: General

“…Interestingly, the foot-sole pump may have greater compliance and patient satisfaction than other lower extremity ICD 1654,1655 . The popular reasons for inpatient non-compliance include heat/sweating, discomfort, and sleep disturbance 1648,1654,1655,[1666][1667][1668] . Since compliance to a lower extremity ICD is generally low and appliances are often placed incorrectly, a smaller, simpler device like the foot pump may be a user-friendlier and better-tolerated choice 1667,1669,1670 .…”

IVC filter placement in patients undergoing surgical treatment of bone or soft‐tissue tumors

“…Our DVT rate of 3.5% is comparable to prior studies analyzing VTE in patients treated with mechanical and chemical prophylaxis (Table 4). [1][2][3][4][5][6][7][8][9] In consideration of chemical anticoagulation following tumor resection, an increased risk for wound complication necessitating return to the operating room, extended duration of antibiotic therapy increasing microbial resistance, increased requirement for opiate pain control, and prolonged immobilization must be weighed. Kaiser et al 3 found that patients treated with chemical anticoagulation had significantly increased risk for wound complication as well as increased risk for VTE.…”

“…Venous thromboembolic events (VTEs), consisting of deep vein thrombus (DVT) and pulmonary embolus (PE), are a concern for musculoskeletal oncologists caring for patients undergoing surgical intervention. Orthopedic surgical interventions are known to increase risk of VTE 1–5 . Risks of VTE are further increased for oncology patients as cancer increases risk of VTE by promoting a hypercoagulable state 6–11 .…”