Pneumatic compression hemodynamics in total hip arthroplasty.
A crossover study was performed to evaluate the effect of several pneumatic compression devices and active dorsoplantar flexion in 10 patients who underwent total hip arthroplasty. Using the Acuson 128XP/10 duplex ultrasound unit with a 5-MHz linear array probe, peak venous velocity and venous volume were assessed above and below the greater saphenous vein and common femoral vein junction. A computer generated randomization table was used to determine the order of the test conditions. The pneumatic compression devices evaluated included two foot pumps, one foot and calf pump, one calf pump, and three calf and thigh pumps. Statistical analyses included analysis of variance and analysis of variance with covariance between devices and patients. The covariates tested were the baseline measurements and the order in which the devices were tested. Differences between devices relate in part to the frequency and rate of inflation and the location and type of compression. Pulsatile calf and foot and calf pneumatic compression with a rapid inflation time produced the greatest increase in peak venous velocity, whereas compression of the calf and thigh showed the greatest increase in venous volume. Because patient and nursing compliance is essential to the success of mechanical prophylaxis for thromboembolic disease, the more simple, yet efficacious, devices that are easier to apply and less cumbersome appear to have a greater likelihood of success. In the active and alert patient, active dorsoplantar flexion should be encouraged.
Westrich
G H
GH
Hospital for Special Surgery, New York, NY 10021, USA.
Specht
L M
LM
Sharrock
N E
NE
Sculco
T P
TP
Salvati
E A
EA
Pellicci
P M
PM
Trombley
J F
JF
Peterson
M
M
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001810:Blood Volume; D018592:Cross-Over Studies; D005081:Exercise Therapy; D005268:Femoral Vein; D005676:Gravity Suits; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D012501:Saphenous Vein; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*