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A randomised comparison of a foot pump and low-molecular-weight heparin in the prevention of deep-vein thrombosis after total knee replacement

Southampton University Hospitals, Tremona Road, Southampton SO16 6YD, UK.

J. Harrison, BSc, PhD, MRPharmS, DipClinPharm, Senior Clinical Pharmacist

North Staffordshire Hospitals, Newcastle Road, Stoke-on-Trent ST4 6QG, UK.

S. Whitehouse, BSc, Research Associate

Department of Orthopaedics

A. Mitchelmore, FRCR, Consultant Radiologist; and M. Thornton, MRCP, FRCR, Consultant Radiologist

Department of Radiology, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.

Correspondence should be sent to Mr D. Warwick.

Patients who undergo total knee replacement (TKR)are at high risk of venous thromboembolism. Low-molecular-weight heparins (LMWH) are the most suitable chemical prophylactic agents but there are some uncertainties about their safety and effectiveness. The foot pump offers an alternative.

We randomised 229 patients undergoing primary, unilateral TKR to receive either the A-V Impulse foot pump or enoxaparin, a LMWH. Ascending venography was undertaken between the sixth and eighth postoperative day in 188 patients without knowledge of the randomisation category. The prevalence of venographic deep-vein thrombosis was 58% (57/99) in the foot-pump group and 54% (48/89) in the LMWH group which was not statistically significant. There were four cases of proximal thrombi and two of fatal pulmonary emboli in the foot-pump group and none in the LMWH group. There were fewer haemorrhagic complications and soft-tissue effects in the foot-pump group.

We conclude that the neither method provides superior prophylaxis.

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