[Can the number of thromboembolisms incidents in total hips replacement be further reduced?]

Is it possible to reduce the rate of thrombembolic events during total hip arthroplasty (THA) by the intraoperative use of a mechanical device for thrombembolic prophylaxis (A-V Impulse System).

The efficacy of additional mechanical thrombembolic prophylaxis was investigated in a prospective randomised trial on 104 patients who underwent cementless THA. All patients received low dose heparin. In 52 patients the additional application of the A-V Impulse System was introduced intraoperatively for the next 24 h. A perfusion scintigram of the lung was performed before and 7 days after the operation in both groups to detect embolic patterns.

Perfusion deficits typical for thromboembolic events were detected postoperatively in 8 patients (15.4 %) of the controls and 5 patients (9.6 %) of the A-V Impulse System group.

With the perfusion lung scan we saw postoperatively a total of 13 patients (12.5 %, n=104) with an asymptomatic microthromboembolism of the lungs. Hence it is necessary to increase the protection against thromboembolism. Although statistically not significant (p=0.374), there is a tendency that the additional use of the mechanical thrombotic prophylaxis can reduce thromboembolic events in THA. The impact of the intraoperative introduction of the A-V Impulse System is not really clear. However, for a higher velocity of blood flow during the operation it makes sense to start the procedure intraoperatively.