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The Journal of Bone and Joint Surgery, Vol 73, Issue 4 507-512, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Intermittent pneumatic compression to prevent proximal deep venous thrombosis during and after total hip replacement. A prospective, randomized study of compression alone, compression and aspirin, and compression and low-dose warfarin
ST Woolson and JM Watt
Stanford University Hospital, California.
A prospective, randomized study of the effectiveness of intraoperative and
postoperative use of intermittent pneumatic compression, alone or in
combination with oral administration of either aspirin or low-dose
warfarin, was done of a consecutive series of patients who had a total hip
replacement and were more than thirty-nine years old. All patients began
walking by the third postoperative day. One hundred and ninety-six patients
who had 217 total hip arthroplasties were included. Twenty-eight per cent
of the procedures were revisions of a previous total hip replacement or of
an endoprosthesis, and the remainder were primary arthroplasties. Patients
were randomized as to the type of prophylaxis that they received:
intermittent pneumatic compression alone, seventy-six hips; intermittent
pneumatic compression and aspirin, seventy-two hips; or intermittent
pneumatic compression and low-dose warfarin, sixty-nine hips. Before
discharge from the hospital, and at an average of seven days after the
operation, all patients were evaluated for the presence of proximal
deep-vein thrombosis with either venography on the side of the operation or
with bilateral venous ultrasonography. The relative frequency with which
thrombosis occurred in a proximal vein was not significantly different in
the three groups; the over-all relative frequency was 10 per cent.
Intermittent compression during and after the operation effectively reduces
the rate of proximal-vein thrombosis after total hip replacement. With the
number of patients in our study, the effectiveness of this technique could
not be shown to be augmented by oral administration of either aspirin or
low-dose warfarin.
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