Graded compression stockings in elective orthopaedic surgeryAN ASSESSMENT OF THE IN VIVO PERFORMANCE OF COMMERCIALLY AVAILABLE STOCKINGS IN PATIENTS HAVING HIP AND KNEE ARTHROPLASTYA. J. Best, FRCS, Specialist Registrar in Orthopaedics; and S. Williams, FRCS, Lecturer in OrthopaedicsDepartment of Orthopaedic Surgery A. Crozier, FRCR, Consultant Radiologist; and R. Bhatt, MB BS, Specialist Registrar in Radiology Department of Radiology, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. P. J. Gregg, MD, FRCS, Professor of Orthopaedics Department of Trauma and Orthopaedic Surgery, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK. A. C. W. Hui, MA, FRCS Ed, Consultant Orthopaedic Surgeon Department of Trauma and Orthopaedic Surgery, Middlesbrough General Hospital, Ayresome Green Lane, Middlesbrough TS5 5AZ, UK. Correspondence should be sent to Mr A. J. Best at Flat 9, Tiffany Court, Albert Road, Stoneygate, Leicester LE2 2AA, UK. We recruited 89 patients who had hip or knee replacements to assess the performance of below-knee graded compression stockings. The pressure gradients generated by the stockings were measured and all patients had venography of the ipsilateral leg. We found that 98% of stockings failed to produce the ideal pressure gradient (± 20%) of 18, 14 and 8 mmHg from the ankle to the knee, while 54% produced a reversed gradient on at least one occasion during the course of the study. The overall rate of deep-venous thrombosis was 16.7%. Stockings which produced reversed gradients were associated with a significantly higher incidence of deep-venous thrombosis (p = 0.026) than those with the correct gradient (25.6% v 6.1%). This suggests that the performance of graded compression stockings can be improved if reversed pressure gradients are detected and prevented.
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