Graduated Compression Stockings for Thromboprophylaxis in Orthopaedic and Trauma Surgery: A Rapid Review and...

Background/Objectives: The utility and value of graduated compression stockings (gCS) as an adjunct to pharmacological thromboprophylaxis, with and without low-molecular-weight heparins (LMWH) and other anticoagulants, in avoiding any thromboembolic (TE) event in the scenario of total joint replacement, fracture management, spine and pelvic surgery, and arthroscopic procedures, remains unclear. Because of the urgent need to decide whether gCS should stay in the portfolio of a national group of nine tertiary trauma centres, our research department was requested to answer the question of whether gCS provide any extra benefit in addition to modern TE prophylaxis in orthopaedic and trauma surgery through a prospectively registered rapid review (PROSPERO CRD42024621104). Methods: We searched PubMed, Ovid MEDLINE, Embase, CINAHL, and CENTRAL from 1 January 1980 to 1 March 2025, for randomised controlled trials (RCTs) and cohort studies comparing TE prophylaxis regimens, both with and without gCS, and modern pharmacological anticoagulants. The methodological quality of individual studies was rated by the Cochrane Collaborations' Risk of Bias Version 2.0 (RoB-2) and the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tools, supplemented by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The reported cumulative incidence of any TE event (i.e., deep vein thrombosis, pulmonary embolism), as defined by individual trialists, was chosen as the primary endpoint, and expressed as the relative risk (RR) between intervention and control groups. Results: Fifteen investigations (13 RCTs and 2 observational studies) enrolling 7721 patients (mean age, 59 [SD 13] years; 3538 males [46%]) with various musculoskeletal conditions and injuries were included. Methodological quality was deemed sufficient to derive meaningful conclusions. The random-effects pooled RR across all studies was 1.15 (95% confidence interval [CI]: 0.80-1.64) in favour of the no-gCS control, but with substantial heterogeneity (I²: 73%). Only three studies investigated the effectiveness of gCS versus no prophylaxis (N = 246, RR: 0.72, 95% CI: 0.43-1.22). Seven studies (N = 5117) compared various combinations of pharmacological prophylaxis, with or without gCS, for a summary RR of 1.44 (95% CI: 0.76-2.72). Conclusions: The results of this rapid review neither show a clear benefit nor support the general use of gCS to prevent TE in orthopaedic and trauma surgery, especially if pharmacological prophylactic measures are established and suitable.