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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 8, 1137-1141.
doi: 10.1302/0301-620X.86B8.15438  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Two mechanical devices for prophylaxis of thromboembolism after total knee arthroplasty

A PROSPECTIVE, RANDOMISED STUDY

P. F. Lachiewicz, MD, Professor1; S. S. Kelley, MD, Clinical Professor2; and L. R. Haden, RN1

1 Department of Orthopaedics, University of North Carolina at Chapel Hill, 3151 Bioinformatics Building, CB 7055, Chapel Hill, North Carolina 27599-7055, USA.
2 North Carolina Orthopaedic Clinic, Duke University Medical Center, 4309 Medical Park Drive, Suite 1008, Durham, North Carolina, 27704, USA.

Correspondence should be sent to Professor P. F. Lachiewicz.

The optimal characteristics of pneumatic compression for mechanical prophylaxis of thromboembolism after total knee arthroplasty (TKA) are not known. Our study compared two methods of calf compression, with the hypothesis that the device which provided a larger increase in peak venous velocity would produce a lower rate of thromboembolism. We performed a prospective, randomised study on 423 patients (472 knees). Duplex ultrasonography was carried out by experienced technicians who were blinded to the device used. Overall, 206 patients (232 knees) used a rapid inflation, asymmetrical compression (RIAC) device and 217 (240 knees) a sequential circumferential compression device (SCD).

The rate of venous thromboembolism was 6.9% with the RIAC device compared with 15% for the SCD device (p = 0.007). The incidence of thrombi with unilateral primary TKA was 8.4% for the RIAC compared with 16.8% for the SCD device (p = 0.03). In 47 patients with a bilateral TKA, the incidence of thrombi was 4% for the RIAC compared with 22.7% for the SCD device (p = 0.05 per knee). There was a low rate of mortality and pulmonary embolism when using mechanical prophylaxis for thromboembolism after TKA. Our findings show that the use of rapid inflation, asymmetrical calf compression gave a significantly lower rate of thromboembolism.




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