Nonpharmacologic thromboembolic prophylaxis in total knee arthroplasty

Deep venous thrombosis is the most common complication in patients having e lective total knee replacement. Pneumatic compression devices play an impor tant role in the prophylaxis of deep venous thrombosis and effectively decr ease the risk of distal deep venous thrombosis. The combination therapy wit h pharmacologic agents has the benefit of decreasing the rate of proximal d eep venous thrombosis and therefore is recommended. In the absence of clini cal data, recent in vivo flow studies suggest that calf or combined foot an d calf compression are superior to foot compression alone. Epidural anesthe sia in comparison with general anesthesia decreases the incidence of thromb oembolic disease after total knee arthroplasty. Although hypotensive anesth esia and intraoperative heparin have been proven to substantially lower the incidence of deep venous thrombosis after total hip arthroplasty, the curr ent literature does not support its ap plication during the implantation of a total knee replacement. Pneumatic compression devices are an important p art of deep venous thrombosis prophylaxis especially in the early postopera tive period considering that pharmacologic anticoagulation is contraindicat ed in the first 12 hours after spinal anesthesia and in the presence of an epidural line.