Intermittent Pneumatic Compression for Venous Thromboembolism Prophylaxis in Total Knee Arthroplasty

Abstract

Venous thromboembolism (VTE) prophylaxis in total knee arthroplasty (TKA) is controversial. The purpose of this study was to evaluate the efficacy of bilateral intra- and postoperative intermittent pneumatic compression without major anticoagulation as prophylaxis for VTE in TKA.This retrospective study involved 157 consecutive patients undergoing TKA performed by 1 surgeon who were treated with bilateral intra- and postoperative intermittent pneumatic compression stockings. All patients were followed for at least 6 weeks postoperatively. Postoperative color duplex ultrasound imaging with compression by certified vascular technologists was obtained for 120 patients 2 to 3 days postoperatively. During hospitalization, 2 (1.7%) patients had acute deep vein thrombosis (DVT) diagnosed, 2 (1.7%) had DVT of indeterminate age, and 4 (3.3%) had chronic DVT. During follow-up, 1 (0.8%) patient had an acute DVT diagnosed at 5 weeks postoperatively and 1 (0.8%) had a superficial phlebitis and subsequently had a nonfatal pulmonary embolism 23 days postoperatively. The predominant chemoprophylaxis used was aspirin alone in 107 (89.2%) patients. Epidural anesthesia was used in the majority (n=96; 80%) of patients.The results of this study support the use of a multimodal approach to VTE prophylaxis in TKA, using bilateral intra- and postoperative intermittent pneumatic compression, epidural anesthesia, early mobilization, and postoperative aspirin without the use of major anticoagulation as an effective, safe VTE prophylactic protocol for patients undergoing elective TKA. The study suggests that the protocol is highly effective, has low morbidity, and is cost effective.