Manual calf massage and passive ankle motion reduce the incidence of deep vein thromboembolism after total hip arthroplasty.
BACKGROUND
Venous thromboembolism is one of the general complications following total hip arthroplasty, wherein various preventive treatments have been recommended. Several studies reported that venous thromboembolism incidence after total hip arthroplasty was similar in patients who were administered prophylaxis with a conventional mechanical procedure alone, and those who were administered pharmacological anticoagulation therapy. Therefore, the optimum methods of prophylaxis are still controversial. The purpose of this study was to investigate whether manual calf massage and passive ankle motion could lower the risk for venous thromboembolism after total hip arthroplasty.


METHODS
We retrospectively reviewed the data of 126 consecutive patients undergoing elective primary unilateral total hip arthroplasty wherein manual calf massage and passive ankle motion were performed after the surgery at our hospitals between January and October 2014. The 138 patients of the control group underwent total hip arthroplasty using the same surgical approach and pre- and postoperative protocols without this mechanical prophylaxis between January and December 2013. This mechanical prophylaxis was performed simultaneously 30 times during approximately 10 s; these procedures were repeated thrice immediately after total hip arthroplasty. Duplex ultrasonography was performed to observe the veins of both legs in all the patients on postoperative day 7.


RESULTS
The incidence of deep vein thrombosis was 6.52% and 0.79% in the control and manual calf massage and passive ankle motion groups, respectively. The odds ratio for the manual calf massage and passive ankle motion groups was 8.72. Performing this mechanical prophylaxis reduced the incidence of venous thromboembolism after total hip arthroplasty. This mechanical prophylaxis is not only simple and easy, but is also safe and inexpensive.


CONCLUSIONS
We therefore recommend that manual calf massage and passive ankle motion be performed in patients who will undergo total hip arthroplasty, if deep vein thrombosis does not exist before the surgery.
Department of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Orthopaedic Surgery, Saiseikai Niigata Daini Hospital, Niigata, Japan. Electronic address: imainorio2001@yahoo.co.jp.
Norio
N
Imai
Department of Orthopaedic Surgery, Saiseikai Niigata Daini Hospital, Niigata, Japan.
Tomoyuki
T
Ito
Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
Ken
K
Suda
Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
Dai
D
Miyasaka
Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
Naoto
N
Endo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007866:Leg; D008297:Male; D008405:Massage; D008875:Middle Aged; D018482:Muscle, Skeletal; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*