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The Journal of Bone and Joint Surgery 80:141-2 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

David Warwick, M.D., F.R.C.S.(Orth) and Steven T. Woolson, M.D.

TO THE EDITOR:

I would value the comments of Woolson on three issues concerning his paper "Intermittent Pneumatic Compression Prophylaxis for Proximal Deep Venous Thrombosis after Total Hip Replacement" (78-A: 1735–1740, Nov. 1996).

First, Woolson concluded that intermittent pneumatic compression is as effective as low-molecular-weight heparin or warfarin in the prevention of proximal deep venous thrombosis. Such a conclusion cannot be made in the absence of a randomized trial. There are too many confounding factors that influence the prevalence of deep venous thrombosis, such as the use of ultrasound rather than venography, ipsilateral rather than bilateral imaging, the day chosen for imaging, the use of adjunctive measures such as graduated elastic stockings and regional anesthesia, and the postoperative mobilization protocol. Only when all of these confounding factors are eliminated by randomization can a valid comparison with another method of prophylaxis by made.

Second, the author used the prevalence of proximal . . . [Full Text of this Article]


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