Venous haemodynamics after total knee arthroplasty

Abstract

We performed a crossover study to evaluate the haemodynamic effect of active dorsal to plantar flexion and seven pneumatic compression devices in ten patients who had a total knee arthroplasty. Using the Acuson 128XP/10 duplex ultrasound unit with a 5MHz linear array probe, we assessed the augmentation of peak venous velocity and venous volume above and below the junction of the greater saphenous and common femoral veins in order to study both the deep and superficial venous systems.The pneumatic compression devices evaluated included two foot pumps (A-V Impulse System and PlexiPulse Foot), a foot-calf pump (PlexiPulse Foot-Calf), a calf pump (VenaFlow System) and three calf-thigh pumps (SCD System, Flowtron DVT and Jobst Athrombic Pump). The devices differed in a number of ways, including the length and location of the sleeve and bladder, the frequency and duration of activation, the rate of pressure rise, and the maximum pressure achieved. A randomisation table was used to determine the order of the test conditions for each patient.The enhancement of peak venous velocity occurred primarily in the deep venous system below the level of the saphenofemoral junction. The increases in peak venous velocity were as follows: active dorsal to plantar flexion 175%; foot pumps, A-V Impulse System 29% and PlexiPulse 65%; foot-calf pump, PlexiPulse, 221%; calf pump, VenaFlow, 302% and calf-thigh pumps, Flowtron DVT 87%, SCD System 116% and Jobst Athrombic Pump 263%.All the devices augmented venous volume, the greatest effect being seen with those incorporating calf compression. The increases in ml/min were found in the deep venous system as follows: foot pumps, A-V Impulse System 9.6 and PlexiPulse Foot 16.7; foot-calf pump, PlexiPulse, 38.1; calf pump, VenaFlow, 26.2; calf-thigh pumps, Flowtron DVT 61.5, SCD System 34.7 and Jobst Athrombic Pump 82.3. Active dorsal to plantar flexion generated 8.5 ml for a single calf contraction.

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

“…Results found the VenaFlow to have the greatest increase in venous volume. 90 This effect was shown below the junction of the greater saphenous vein and the common femoral vein, namely in the deep venous system. 90 A similar study performed at the Hospital for Special Surgery investigated the same set of mechanical devices in patients undergoing total hip arthroplasty.…”

“…90 This effect was shown below the junction of the greater saphenous vein and the common femoral vein, namely in the deep venous system. 90 A similar study performed at the Hospital for Special Surgery investigated the same set of mechanical devices in patients undergoing total hip arthroplasty. 102 Similarly, results found the VenaFlow device to have the greatest influence on venous velocity among this cohort of patients undergoing total hip arthroplasty (see Table 2).…”

“…Such devices have been shown to have the greatest increase in peak venous velocity. 30,90,102 In addition, studies have shown stimulation of the fibrinolytic system with the use of intermittent compression devices. 22,85 The advantage of boot or stocking mechanical devices is that they can be applied to the nonoperative leg preoperatively and then postoperatively on the operative extremity.…”

“…90 All of the pneumatic compression devices that were investigated in the crossover study augmented both peak venous velocity and venous volume. The first study involved a comparison of 7 different types of mechanical compression devices on a cohort of patients undergoing total knee arthroplasty.…”

“…Findings from both crossover studies comparing venous hemodynamics in 7 mechanical compression devices found the VenaFlow high-flow calf compression device to produce the greatest increase in peak venous velocity at the common femoral vein of over 300% in a cohort of patients undergoing total knee and total hip arthroplasty. 90,102 On the basis of this hemodynamics study, a metaanalysis investigating thromboembolic prophylaxis after total knee arthroplasty was done at our institution. 90,106 Results also demonstrated that calf compression devices (with or without sequential foot compression and which specifically work with an asymmetric multichamber system that applies at least 50 mm Hg of sequential external pressure at a frequency of at least once per minute and an inflation time of less than 1 second) is the ideal device for prophylaxis against DVT in patients undergoing total knee arthroplasty.…”