[Can the number of thromboembolisms incidents in total hips replacement be further reduced?].
OBJECTIVE
Is it possible to reduce the rate of thrombembolic events during total hip arthroplasty (THA) by the intraoperative use of a mechanical device for thrombembolic prophylaxis (A-V Impulse System).


METHODS
The efficacy of additional mechanical thrombembolic prophylaxis was investigated in a prospective randomised trial on 104 patients who underwent cementless THA. All patients received low dose heparin. In 52 patients the additional application of the A-V Impulse System was introduced intraoperatively for the next 24 h. A perfusion scintigram of the lung was performed before and 7 days after the operation in both groups to detect embolic patterns.


RESULTS
Perfusion deficits typical for thromboembolic events were detected postoperatively in 8 patients (15.4 %) of the controls and 5 patients (9.6 %) of the A-V Impulse System group.


CONCLUSIONS
With the perfusion lung scan we saw postoperatively a total of 13 patients (12.5 %, n=104) with an asymptomatic microthromboembolism of the lungs. Hence it is necessary to increase the protection against thromboembolism. Although statistically not significant (p=0.374), there is a tendency that the additional use of the mechanical thrombotic prophylaxis can reduce thromboembolic events in THA. The impact of the intraoperative introduction of the A-V Impulse System is not really clear. However, for a higher velocity of blood flow during the operation it makes sense to start the procedure intraoperatively.
Anders
J O
JO
Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena am Waldkrankenhaus Rudolf-Elle Eisenberg gGmbH. joand@t-online.de
Fuhrmann
R
R
Roth
A
A
Zenker
C
C
D000368:Aged; D002484:Cementation; D019544:Equipment Failure Analysis / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation*; D008297:Male; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011475:Prosthesis Failure; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D016896:Treatment Outcome