Intermittent pneumatic compression for venous thromboembolism prophylaxis in total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Vascular Medicine
• Anesthesiology

Background:

• Venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA) remains a debated topic.
• Current prophylactic strategies often involve significant anticoagulation, posing risks.
• There is a need for effective VTE prophylaxis with reduced morbidity.

Purpose of the Study:

• To assess the efficacy of bilateral intermittent pneumatic compression (IPC) stockings, used intraoperatively and postoperatively, as a VTE prophylaxis in TKA.
• To evaluate this approach without the routine use of major anticoagulation.
• To determine the safety and effectiveness of a multimodal VTE prophylaxis protocol.

Main Methods:

• Retrospective analysis of 157 consecutive TKA patients treated with bilateral IPC stockings.
• Follow-up of all patients for at least 6 weeks postoperatively.
• Postoperative duplex ultrasound screening for deep vein thrombosis (DVT) in 120 patients.

Main Results:

• A low incidence of VTE was observed: 1.7% acute DVT during hospitalization, 0.8% acute DVT during follow-up.
• One case of superficial phlebitis and one nonfatal pulmonary embolism occurred during follow-up.
• The majority of patients received aspirin as chemoprophylaxis (89.2%) and epidural anesthesia (80%).

Conclusions:

• A multimodal approach combining IPC stockings, epidural anesthesia, early mobilization, and aspirin is an effective VTE prophylaxis for TKA.
• This protocol demonstrates low morbidity and cost-effectiveness.
• The findings support the use of IPC stockings as a primary VTE prophylaxis in TKA, minimizing the need for major anticoagulation.