Total knee replacement: prevention of deep-vein thrombosis using pharmacological (low-molecular-weight heparin) and mechanical (intermittent foot sole pump system) combined prophylaxis. Preliminary results.
OBJECTIVE
The aim of this study was to determine the role of combined mechanical and pharmacological prophylaxis in the prevention of deep venous thrombosis (DVT) after total knee replacement (TKR).


METHODS
prospective case series study.


METHODS
Between October 2002 and June 2003, 38 total knee procedures were carried out on 34 patients (4 patients had bilateral TKR). To exclude the presence of a concomitant DVT echo-color-flow of the legs was performed between 2 and 1 week prior to surgery, in the postoperative period (before discharging) and 30 days after surgery. Patients received one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight). An intermittent foot sole pump (IFSP) was applied in the recovery room postoperatively, in both feet for about 5 h a day and all night long, and continued at home until the 15(th) day.


RESULTS
No major perioperative or rehabilitation phase-related complications were observed (2 patients required manual drainage of blood clots from the wound). The incidence of DVT was 7.9% (3 cases). In one of these cases we observed a previous DVT so it was classified as rethrombosis. All were successfully treated with therapeutic introduced low molecular weight heparin (LMWH) therapy. No pulmonary embolism or deaths associated with the use of LMWH or IFSP were observed.


CONCLUSIONS
In our experience the combined prophylaxis with nadroparin calcium and IFSP significantly reduced the incidence of DVT.
Giannoni
M F
MF
Department of Vascular Surgery, La Sapienza University of Rome, Rome, Italy. mariafabrizia.giannoni@uniroma1.it
Ciatti
R
R
Capoccia
L
L
Ruggiero
M
M
Dauri
M
M
Mariani
P P
PP
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003131:Combined Modality Therapy; D018618:Echocardiography, Doppler, Color; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000473:pathology; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000473:pathology; D015994:Incidence; D007279:Injections, Subcutaneous; D048228:Intermittent Pneumatic Compression Devices; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use*; D020370:Osteoarthritis, Knee / Q000601:surgery; D010020:Osteonecrosis / Q000601:surgery; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D017762:Nadroparin