Efficacy of prophylaxis against thromboembolism with intermittent pneumatic compression after primary and revision total hip arthroplasty

Background Thromboembolism is a common and important complication after tot al hip arthroplasty, A variety of pharmacological and mechanical measures h ave been proposed for prophylaxis, The purpose of the present study was to evaluate the efficacy of intermittent pneumatic compression as prophylaxis against thromboembolism following total hip arthroplasty, Methods: The prospective study involved a consecutive series of 425 patient s in whom a total of 502 (324 primary and 178 revision) total hip arthropla sties had been performed by two surgeons. The patients were managed intraop eratively and postoperatively with use of thigh-high elastic compression st ockings and thigh-high intermittent pneumatic compression sleeves. Experien ced vascular technologists performed venous duplex ultrasonography on both lower extremities of all patients at a mean of six days (range, two to fift een days) postoperatively, All patients were followed for at least one year in order to detect late thromboembolism. Results: An asymptomatic deep-vein thrombosis was noted on the scans made a fter twenty-three (4.6 percent) of the 502 procedures. Nineteen (3.8 percen t) of the arthroplasties were followed by the development of a proximal thr ombosis and four (0.8 percent), a distal thrombosis. Nineteen of the thromb oses were ipsilateral (eighteen mere proximal and one, distal), and four we re contralateral (one was proximal and three, distal), No symptomatic deep- vein thrombosis developed in the hospital. In addition, three (two proximal and one distal) symptomatic ipsilateral deep-vein thromboses (a prevalence of 0.6 percent) developed three to twenty-three weeks after postoperative scans revealed negative findings and the patients were discharged from the hospital. Three symptomatic pulmonary embolisms (a prevalence of 0.6 percen t) were confirmed by ventilation-perfusion scanning while the patients were in the hospital. There were no symptomatic pulmonary embolisms after disch arge, and there were no fatal pulmonary embolisms, With the numbers availab le, we were unable to detect an association between deep-vein thrombosis an d age (p = 0.76), gender (p = 0.13), body-mass index (p = 0.12), type of ar throplasty (primary or revision) (p = 0.12), operative approach (p = 0.37), duration of the operation (p = 0.21), type of anesthesia (general or regio nal) (p = 0.51), units of blood transfused (autologous, p = 0.79; homologou s, p = 0.57), blood type (p = 0.18), or the presence of a so-called classic risk factor for the development of thrombosis (p = 0.22). Five arthroplast ies (1.0 percent) were followed by the development of a wound hematoma, but only one hematoma necessitated operative drainage. Conclusions: The use of intraoperative and postoperative thigh-high intermi ttent pneumatic compression, combined with duplex ultrasonography performed by experienced vascular technologists, is effective for prophylaxis agains t thromboembolism after both primary and revision total hip arthroplasties. The low prevalence of deep-vein thrombosis (4.6 percent) and symptomatic p ulmonary embolism (0.6 percent) is comparable with that associated with pha rmacological prophylaxis.