title: Less deep vein thrombosis due to transcutaneous fibular nerve stimulation in total knee arthroplasty: a randomized controlled trial.
abstract: OBJECTIVE
  It has been known for years that deep vein thrombi (DVT) start to develop during total joint arthroplasty. Previously, we reported effective prevention of venous stasis by transcutaneous electrical nerve stimulation (TENS). It is hypothesized that TENS might be a thromboprophylactic tool for the limb undergoing surgery. The purpose of this study is to clarify the clinical efficacy and safety of TENS in patients during total knee arthroplasty (TKA).
  
  
  METHODS
  Ninety patients undergoing primary TKA were involved and randomly allocated to the TENS or control group. In the TENS group, electrical stimulation of the common fibular nerve, which produced a brisk dorsiflexion of the ankle, was performed for the operated leg during surgery. In the control group, no electrical stimulation was applied. Serum D-dimer and soluble fibrin monomer complex (SFMC) levels were measured before surgery, immediately after surgery, and post-operative day (POD) 1. Ultrasonography was performed on POD 1.
  
  
  RESULTS
  Immediately after surgery, D-dimer and SFMC levels of each group were significantly lower in the TENS group compared with control (p < 0.05). The incidence of DVT was 11 % (five cases) in the TENS group while 31 % (14 cases) in control (p = 0.02). There were no adverse effects related to TENS.
  
  
  CONCLUSIONS
  TENS during TKA showed significant effects on preventing DVT. Sustaining muscle pump activation during surgery prevented not only venous stasis, but also hypercoagulability of blood. Intraoperative TENS is a safe and novel strategy against early post-operative thromboembolism, which is difficult to be completed through existing prophylaxis after total joint arthroplasty.
  
  
  METHODS
  Randomized controlled trial, Level I.
authors: Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan.
authors: Masashi
authors: M
authors: Izumi
authors: Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan. ikeuchim@kochi-u.ac.jp.
authors: Masahiko
authors: M
authors: Ikeuchi
authors: Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan.
authors: Koji
authors: K
authors: Aso
authors: Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan.
authors: Natsuki
authors: N
authors: Sugimura
authors: Department of Anesthesiology, Kochi University, Nankoku, Japan.
authors: Yuko
authors: Y
authors: Kamimoto
authors: Department of Clinical Laboratory, Kochi University, Nankoku, Japan.
authors: Tetsuya
authors: T
authors: Mitani
authors: Department of Clinical Laboratory, Kochi University, Nankoku, Japan.
authors: Tadashi
authors: T
authors: Ueta
authors: Department of Cardiovascular Control, Kochi University, Nankoku, Japan.
authors: Takayuki
authors: T
authors: Sato
authors: Department of Anesthesiology, Kochi University, Nankoku, Japan.
authors: Masataka
authors: M
authors: Yokoyama
authors: Department of Clinical Laboratory, Kochi University, Nankoku, Japan.
authors: Tetsuro
authors: T
authors: Sugiura
authors: Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan.
authors: Toshikazu
authors: T
authors: Tani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D010543:Peroneal Nerve; D012307:Risk Factors; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
keywords: Deep vein thrombosis (DVT); Prevention; Pulmonary thromboembolism (PTE); Total knee arthroplasty (TKA); Transcutaneous electrical nerve stimulation (TENS); Venous thromboembolism (VTE)