The prospective study involved a consecutive series of 425 patients in whom a total of 502 (324 primary and 178 revision)
total hip arthroplasties had been performed by two surgeons. The patients were managed intraoperatively and postoperatively with use of thigh-high elastic
compression stockings and thigh-high intermittent pneumatic compression sleeves. Experienced vascular technologists performed venous duplex ultrasonography on both lower extremities of all patients at a mean of six days (range, two to fifteen days) postoperatively. All patients were followed for at least one year in order to detect late
thromboembolism.
RESULTS: An asymptomatic
deep-vein thrombosis was noted on the scans made after twenty-three (4.6 percent) of the 502 procedures. Nineteen (3.8 percent) of the
arthroplasties were followed by the development of a proximal
thrombosis and four (0.8 percent), a distal
thrombosis. Nineteen of the
thromboses were ipsilateral (eighteen were proximal and one, distal), and four were contralateral (one was proximal and three, distal). No symptomatic
deep-vein thrombosis developed in the hospital. In addition, three (two proximal and one distal) symptomatic ipsilateral
deep-vein thromboses (a prevalence of 0.6 percent) developed three to twenty-three weeks after postoperative scans revealed negative findings and the patients were discharged from the hospital. Three symptomatic
pulmonary embolisms (a prevalence of 0.6 percent) were confirmed by ventilation-perfusion scanning while the patients were in the hospital. There were no symptomatic
pulmonary embolisms after discharge, and there were no fatal
pulmonary embolisms. With the numbers available, we were unable to detect an association between
deep-vein thrombosis and age (p = 0.76), gender (p = 0.13), body-mass index (p = 0.12), type of
arthroplasty (primary or revision) (p = 0.12), operative approach (p = 0.37), duration of the operation (p = 0.21), type of
anesthesia (general or regional) (p = 0.51), units of blood transfused (autologous, p = 0.79; homologous, p = 0.57), blood type (p = 0.18), or the presence of a so-called classic risk factor for the development of
thrombosis (p = 0.22). Five
arthroplasties (1.0 percent) were followed by the development of a
wound hematoma, but only one
hematoma necessitated operative drainage.
CONCLUSIONS: The use of intraoperative and postoperative thigh-high intermittent pneumatic compression, combined with duplex ultrasonography performed by experienced vascular technologists, is effective for prophylaxis against
thromboembolism after both primary and revision
total hip arthroplasties. The low prevalence of
deep-vein thrombosis (4.6 percent) and symptomatic
pulmonary embolism (0.6 percent) is comparable with that associated with pharmacological prophylaxis.