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The Journal of Bone and Joint Surgery (American) 84:1998-2004 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Effect of Mechanical Compression on the Prevalence of Proximal Deep Venous Thrombosis as Assessed by Magnetic Resonance Venography

Michael G. Ryan, MD, Geoffrey H. Westrich, MD, Hollis G. Potter, MD, Nigel Sharrock, MD, Lena M. Maun, BA, William Macaulay, MD, Pamela Katkin, PAC, Thomas P. Sculco, MD and Eduardo A. Salvati, MD

Investigation performed at The Hospital for Special Surgery, New York, NY

Michael G. Ryan, MD
Geoffrey H. Westrich, MD
Hollis G. Potter, MD
Nigel Sharrock, MD
Lena M. Maun, BA
Pamela Katkin, PAC
Thomas P. Sculco, MD
Eduardo A. Salvati, MD
Departments of Orthopedics (M.G.R., G.H.W., L.M.M., P.K., T.P.S, and E.A.S.), Radiology (H.G.P), and Anesthesiology (N.S.), The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for G.H. Westrich: westrichg{at}hss.edu

William Macaulay, MD
Department of Orthopaedic Surgery, Columbia-Presbyterian Medical Center, 622 West 168th Street, New York, NY 10032
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Aircast Incorporated. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Patients have been shown to be at greater risk for deep venous thrombosis, particularly proximal thrombosis, after total hip arthroplasty. Proximal thrombi are more likely to develop into pulmonary emboli than are distal thrombi. The purpose of this randomized, prospective study was to compare the prevalence of pelvic and proximal lower-extremity deep venous thrombosis after primary total hip arthroplasty between patients treated with an impulse mechanical compression device for prophylaxis and those treated with prophylactic stockings.

Methods: One hundred patients were evaluated, with use of magnetic resonance venography, for proximal deep venous thrombosis after total hip arthroplasty. Fifty patients were treated with a mechanical compression device on both lower extremities, and the other fifty patients received only prophylactic stockings. Both groups of patients received hypotensive epidural anesthesia and 325 mg of aspirin twice a day.

Results: Overall, proximal deep venous thrombi were found in 15% of the 100 patients. Of the fifty patients treated with mechanical compression, 8% (four) had a positive venogram. Of the fifty control patients, 22% (eleven) had a positive venogram (p < 0.05). However, overall the rate of occlusive thrombi was 6% (six) compared with an overall rate of nonocclusive thrombi of 9% (nine). The rate of occlusive thrombi was 2% (one of fifty) in the study group and 10% (five of fifty) in the control group (p = 0.04).

Conclusions: On the basis of this study, we concluded that patients managed with total hip arthroplasty benefit from a reduction in the rates of femoral and pelvic deep vein thrombosis when they are treated with hypotensive epidural anesthesia, mechanical compression, and aspirin and are subsequently assessed with magnetic resonance venography.


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