Thromboembolic disease prophylaxis in total knee arthroplasty using intraoperative heparin and postoperative pneumatic foot compression

A prospective study was performed to assess the clinical efficacy of intrao perative heparin combined with postoperative pneumatic foot compression and aspirin for thromboembolic disease prophylaxis after primary total knee ar throplasty (TKA). This group of 48 patients all had a primary TKA performed under epidural anesthesia. The cohort of patients was compared with a simi lar cohort of patients matched for age and comorbidity. The control group c onsisted of 61 patients (41 unilateral patients, 20 bilateral patients) wit h 81 TKAs who received epidural anesthesia and postoperative pneumatic foot compression and aspirin. The same surgeon and anesthesiologist performed a ll cases. All patients had the pneumatic foot compression device applied in the recovery room and received 325 mg of enteric-coated aspirin twice a da y beginning the night of surgery. Venography was performed on the fifth pos toperative day for both groups to determine the incidence of deep vein thro mbosis (DVT). In the control group with postoperative pneumatic foot compre ssion (group 1), the overall incidence of DVT was 27% (22 of 81), with 10% (8 of 81) major calf DVT and no proximal (popliteal or femoral) DVT. In the study group with intraoperative heparin and postoperative pneumatic foot c ompression (group 2), the overall incidence of DVT was 25% (12 of 48), with 8% (4 of 48) major calf DVT and no proximal DVT. There was no statisticall y significant difference between groups 1 and 2 for the incidence of overal l DVT (P > .05) or major calf DVT (P > .05). No complications were associat ed with the use of intraoperative heparin or the pneumatic compression devi ce, and no patient developed a symptomatic pulmonary embolism up to 3 month s postoperatively. Although this study confirms that pneumatic foot compres sion combined with aspirin is an effective form of DVT prophylaxis after TK A, the added benefit of intraoperative heparin was not statistically proven . Although greater statistical power is needed to determine whether intraop erative heparin provides an added benefit, this study reveals a low inciden ce of DVT in TKA with this protocol.