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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 5, 639-642.
doi: 10.1302/0301-620X.86B5.14763  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Mechanical prophylaxis of deep-vein thrombosis after total hip replacement

A RANDOMISED CLINICAL TRIAL

R. P. Pitto, MD, PhD, Associate Professor, Consultant Orthopaedic Surgeon1; H. Hamer, MD, Consultant Physician2; W. Heiss-Dunlop, MD, Senior Orthopaedic Registrar1; and J. Kuehle, MD, Consultant Orthopaedic Surgeon3

1 Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, PO Box 93311, Auckland, New Zealand.
2 Department of Internal Medicine, Waldkrankenhaus, Rathsbergerstrasse 57, D-91054 Erlangen, Germany.
3 Department of Orthopaedics, Friedrich-Alexander, University Erlangen-Nuremberg, Waldkrankenhaus, Rathsbergerstrasse 57, D-91054 Erlangen, Germany.

Correspondence should be sent to Dr R. P. Pitto.

Routine prophylaxis for venous thromboembolic disease after total hip replacement (THR) is recommended. Pneumatic compression with foot pumps seems to provide an alternative to chemical agents. However, the overall number of patients investigated in randomised clinical trials has been too small to draw evidence-based conclusions. This randomised clinical trial was carried out to compare the effectiveness and safety of mechanical versus chemical prophylaxis of DVT in patients after THR.

Inclusion criteria were osteoarthritis of the hip and age less than 80 years. Exclusion criteria included a history of thromboembolic disease, heart disease, and bleeding diatheses. There were 216 consecutive patients considered for inclusion in the trial who were randomised either for management with the A-V Impulse System foot pump. We excluded 16 patients who did not tolerate continuous use of the foot pump or with low-molecular-weight heparin (LMWH). Patients were monitored for DVT using serial duplex sonography at 3, 10 and 45 days after surgery.

DVT was detected in three of 100 patients in the foot-pump group and with six of 100 patients in the LMWH group (p < 0.05). The mean post-operative drainage was 259 ml in the foot-pump group and 328 ml in the LMWH group (p < 0.05). Patients in the foot-pump group had less swelling of the thigh (10 mm compared with 15 mm; p < 0.05). One patient developed heparin-induced thrombocytopenia. This study confirms the effectiveness and safety of mechanical prophylaxis of DVT in THR. Some patients cannot tolerate the foot pump.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General