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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 5, 562-569.
doi: 10.1302/0301-620X.90B5.19744  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Multimodal thromboprophylaxis following primary hip arthroplasty

THE ROLE OF ADJUVANT INTERMITTENT PNEUMATIC CALF COMPRESSION

J. Daniel, FRCS, Director of Research1; A. Pradhan, MBChB, Orthopaedic Specialist Trainee2; C. Pradhan, FRCS, Staff Orthopaedic Surgeon1; H. Ziaee, BSc(Hons), Biomedical Scientist1; M. Moss, FRCR, Consultant Radiologist3; J. Freeman, FRCA, Consultant Anaesthesiologist3; and D. J. W. McMinn, FRCS, Consultant Orthopaedic Surgeon1

1 The McMinn Centre, 25 Highfield Road, Birmingham B15 3DP, UK.
2 University Hospital North Staffordshire and City General Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, UK.
3 Birmingham Nuffield Hospital, 22 Somerset Road, Birmingham B15 2QQ, UK.

Correspondence should be sent to Mr J. Daniel; e-mail: josephdaniel{at}mcminncentre.co.uk

We report a retrospective review of the incidence of venous thromboembolism in 463 consecutive patients who underwent primary total hip arthroplasty (487 procedures). Treatment included both total hip replacement and hip resurfacing, and the patients were managed without anticoagulants. The thromboprophylaxis regimen included an antiplatelet agent, generally aspirin, hypotensive epidural anaesthesia, elastic compression stockings and early mobilisation. In 258 of these procedures (244 patients) performed in 2005 (cohort A) mechanical compression devices were not used, whereas in 229 (219 patients) performed during 2006 (cohort B) bilateral intermittent pneumatic calf compression was used.

All operations were performed through a posterior mini-incision approach. Patients who required anticoagulation for pre-existing medical problems and those undergoing revision arthroplasty were excluded. Doppler ultrasonographic screening for deep-vein thrombosis was performed in all patients between the fourth and sixth post-operative days. All patients were reviewed at a follow-up clinic six to ten weeks after the operation. In addition, reponse to a questionnaire was obtained at the end of 12 weeks post-operatively.

No symptomatic calf or above-knee deep-vein thrombosis or pulmonary embolism occurred. In 25 patients in cohort A (10.2%) and in ten patients in cohort B (4.6%) asymptomatic calf deep-vein thromboses were detected ultrasonographically. This difference was statistically significant (p = 0.03). The regimen followed by cohort B offers the prospect of a low incidence of venous thromboembolism without subjecting patients to the higher risk of bleeding associated with anticoagulant use.






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