Effectiveness of Mechanical Devices in Orthopedic Surgery

Chapter

Abstract

Orthopedic surgeons are intuitively drawn to mechanical thromboprophylactic methods because of the perceived lack of bleeding complications, fear of which inhibits universal acceptance of effective chemical methods. Some mechanical methods such as graduated stockings, foot pumps, and calf compressors have a good evidence base with studies showing a consistent reduction in thrombosis. Drawbacks include cost, convenience, and compliance. The ideal role is in conjunction with, rather than in competition with, chemical methods.

Keywords

Thromboembolism Foot pumps Graduated stockings Intermittent pneumatic compression Orthopedics 

Notes

Glossary

ACCP

American College of Chest Physicians

DVT

Deep vein thrombosis

GCS

Graduated compression stockings

ICS

International Consensus Statement

IPC

Intermittent pneumatic compression

LMWH

Low molecular weight heparin

NICE

National Institute of Health and Clinical Excellence

PA

Pulmonary embolism

THR

Total hip replacement

TKR

Total knee replacement

US

Ultrasound

VTE

Venous thromboembolism

References

  1. 1.
    Geerts WH, et al. Prevention of venous thromboembolism. The 8th ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2008;133:381S–453.PubMedCrossRefGoogle Scholar
  2. 2.
    Nicolaides AN, et al. Prevention and treatment of venous thromboembolism. International consensus statement (guidelines according to scientific evidence). Int Angiol. 2006;25(2):101–61.Google Scholar
  3. 3.
    NICE clinical guideline 92. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. 2010. Available at: http://www.nice.org.uk/guidance. Accessed 10 Aug 2012.
  4. 4.
    Roderick P, Ferris G, Wilson K, Halls H, Jackson D, Collins R, Baigent C. Towards evidence based guidelines for the prevention of venous thromboembolism: systematic review of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess. 2005;9(49):iii–iv, ix–x, 1–78.PubMedGoogle Scholar
  5. 5.
    Virchow RLK. Die verstopfung den lungenarterie und ihre flogen. Beitr Exper Path Physiol. 1846;2:227–380.Google Scholar
  6. 6.
    Wessler S, Yin ET, Gaston LW. A distinction between the role of precursor and activated forms of clotting factors in the genesis of venous thrombi. Thromb Diath Haemorrh. 1967;18:12–20.PubMedGoogle Scholar
  7. 7.
    Ogawa S, Gerlach H, Esposito C, Pasagian-Macaulay A, Brett J, Stern D. Hypoxia modulates the barrier and coagulant function of cultured bovine endothelium. J Clin Invest. 1990;85:1090–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Hamer JD, Lalone PC, Silver IA. The pO2 in venous valve pockets: its possible bearing on thrombogenesis. Br J Surg. 1981;68:166–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Stamatakis JD, Kakkar VV, Sager S, Lawrence D, Nairn D, Bentley PG. Femoral vein thrombosis and total hip replacement. Br Med J. 1977;2:223–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Planès A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis. J Bone Joint Surg Br. 1990;72-B:9–13.Google Scholar
  11. 11.
    Binns M, Pho R. Femoral vein occlusion during hip arthroplasty. Clin Orthop. 1990;255:168–72.PubMedGoogle Scholar
  12. 12.
    Warwick DJ, Martin A, Glew D, Bannister GC. Measurement of femoral vein blood flow during total hip replacement. Duplex ultrasound with and without the use of a foot-pump. J Bone Joint Surg Br. 1994;76-B:918–21.Google Scholar
  13. 13.
    Gardner AMN, Fox RH. The return of blood to the heart: venous pumps in health and disease. London: John Libby and Co; 2001.Google Scholar
  14. 14.
    McNally MA, Badahur R, Cooke EA, Mollan RA, et al. Venous haemodynamics in both legs after total knee replacement. J Bone Joint Surg Br. 1997;79:633–7.PubMedCrossRefGoogle Scholar
  15. 15.
    McNally MA, Cooke EA, Mollan RA. Femoral vein blood flow during THR. J Bone Joint Surg Br. 1993;75:640–4.PubMedGoogle Scholar
  16. 16.
    Wilson D, Cooke EA, McNally MA, Yeates A, Mollan RA. Altered venous function and deep venous thrombosis following proximal femoral fracture. Injury. 2001;33:33–9.CrossRefGoogle Scholar
  17. 17.
    Sharrock NE, Go G, Sculco TP, Ranawat CS, Maynard MJ, Harpel PC. Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet. J Arthroplasty. 1995;10:523–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Sharrock NE, Go G, Williams-Russo P, Haas SB, Harpel PC. Comparison of extradural and general anaesthesia on the fibrinolytic response to total knee arthroplasty. Br J Anaesth. 1997;79:29–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop. 2000;371:169–77.Google Scholar
  20. 20.
    Harvey EJ, Leclerc J, Books CE, Burke DL. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty. 1997;12:291–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Berman AT, Parmet JL, Harding SP, Israelite CL, Chandrasekaran K, Horrow JC, Singer R, Rosenberg H. Emboli observed with use of transesophageal echocardiography immediately after tourniquet release during total knee arthroplasty with cement. J Bone Joint Surg Am. 1998;80-A:389–96.Google Scholar
  22. 22.
    Von Schroeder HP, Coutts RD, Billings E, Mai MT, Aratow M. The changes in intramuscular pressure and femoral vein flow with continuous passive motion, pneumatic compressive stockings, and leg manipulations. Clin Orthop. 1991;266:218–26.Google Scholar
  23. 23.
    Westrich GH, Sculco TP. Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg Am. 1996;78:826–34.PubMedGoogle Scholar
  24. 24.
    Ljungnér H, Bergqvist D, Nilsson IM. Effect of intermittent pneumatic and graduated static compression on factor VIII and the fibrinolytic system. Acta Chir Scand. 1981;147:657–61.PubMedGoogle Scholar
  25. 25.
    Jacobs DG, Piotrowski JJ, Hoppensteadt DA, Salvator AE, Fareed J. Hemodynamic and fibrinolytic consequences of intermittent pneumatic compression: preliminary results. J Trauma. 1996;40:710–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Comerota AJ, Chouhan V, Harada RN, Sun L, Hosking J, Veermansunemi R, Comerota Jr AJ, Schlappy D, Rao AK. The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis. Ann Surg. 1997;226:306–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Kessler CM, Hirsch DR, Jacobs H, MacDougall R, Goldhaber SZ. Intermittent pneumatic compression in chronic venous insufficiency favorably affects fibrinolytic potential and platelet activation. Blood Coagul Fibrinolysis. 1996;7:437–46.PubMedCrossRefGoogle Scholar
  28. 28.
    Morris RJ, Woodcock JP. Evidence-based compression: prevention of stasis and deep vein thrombosis. Ann Surg. 2004;239:162–71.PubMedCrossRefGoogle Scholar
  29. 29.
    Guyton DP, Khayat A, Husni EA, Schreiber H. Elevated levels of 6-keto-prostaglandin-F1α from a lower extremity during external pneumatic compression. Surg Gynecol Obstet. 1988;166:338–42.PubMedGoogle Scholar
  30. 30.
    Dai G, Tsukurov O, Chen M, Gertler JP, Kamm RD. Endothelial nitric oxide production during in vitro simulation of external limb compression. Am J Physiol Heart Circ Physiol. 2002;282:H2066–75.PubMedGoogle Scholar
  31. 31.
    Giddings JC, Morris RJ, Ralis HM, Jennings GM, Davies DA, Woodcock JP. Systemic haemostasis after intermittent pneumatic compression. Clues for the investigation of DVT prophylaxis and travellers thrombosis. Clin Lab Haematol. 2004;26:269–73.PubMedCrossRefGoogle Scholar
  32. 32.
    Knight MT, Dawson R. Effect of intermittent compression of the arms on deep venous thrombosis in the legs. Lancet. 1976;2:1265–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Buehler KO, D’Lima DD, Petersilge WJ, Colwell CW, Walker RH. Late deep venous thrombosis and delayed weight bearing after total hip arthoplasty. Clin Orthop. 1999;361:123–30.PubMedCrossRefGoogle Scholar
  34. 34.
    Lassen MR, Borris LC. Mobilisation after hip surgery and efficacy of thromboprophylaxis. Lancet. 1991;337:618.PubMedCrossRefGoogle Scholar
  35. 35.
    Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Modig J. Influence of regional anesthesia, local anesthetics and sympathicomimetics on the pathophysiology of deep vein thrombosis. Acta Chir Scand Suppl. 1988;550:119–27.Google Scholar
  37. 37.
    Knaggs AL, Delis KT, Mason P, Macleod K. Perioperative lower limb venous haemodynamics in patients under general anaesthesia. Br J Anaesth. 2005;94:292–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Sharrock NE, Haas SB, Hargett MJ, Urquhart B, Insall JN, Scuderi G. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am. 1991;73-A:502–6.Google Scholar
  39. 39.
    Lieberman JR, Huo MH, Hanway J, Salvati EA, Sculco TP, Sharrock NE. The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia. J Bone Joint Surg Am. 1994;76-A:341–8.Google Scholar
  40. 40.
    Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med. 2003;28:172–97.PubMedGoogle Scholar
  41. 41.
    Lawrence D, Kakkar VV. Graduated, static, external compression of the lower limb: a physiological assessment. Br J Surg. 1980;67:119–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Rosengarten DS, Laird J, Jeyasingh K, Martin P. The failure of compression stockings (Tubigrip) to prevent deep venous thrombosis after operation. Br J Surg. 1970;57:296–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Jeffery PC, Nicolaides AN. Graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg. 1990;77:380–3.PubMedCrossRefGoogle Scholar
  44. 44.
    Coleridge-Smith PD, Hasty JH, Scurr JH. Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf. Br J Surg. 1991;78:724–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Ingram JE. A review of thigh-length vs knee-length antiembolism stockings. Br J Nurs. 2003;12:845–51.PubMedGoogle Scholar
  46. 46.
    Wildin CJ, Hui AC, Esler CN, Gregg PJ. In vivo pressure profiles of thigh-length graduated compression stockings. Br J Surg. 1998;85:1228–31.PubMedCrossRefGoogle Scholar
  47. 47.
    Best AJ, Williams S, Crozier A, Bhatt R, Gregg PJ, Hui AC. Graded compression stockings in elective orthopaedic surgery. An assessment of the in vivo performance of commercially available stockings in patients having hip and knee arthroplasty. J Bone Joint Surg Br. 2000;82:116–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Amarigiri SV, Lees TA (2000) Elastic compression stockings for prevention of venous thrombosis. Cochrane Database Syst Rev. 2000;(3):CD001484.Google Scholar
  49. 49.
    Warwick D, Roschensher N. The “critical thrombosis period” in major orthopedic surgery: when to start and when to stop prophylaxis. Clin Appl Thromb Hemost. 2010;16(4):394–405.PubMedCrossRefGoogle Scholar
  50. 50.
    Warwick DJ, et al. Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events. J Bone Joint Surg Br. 2007;89B:799–807.Google Scholar
  51. 51.
    Elliot CG, Dudney TM, Egger M, Orme JF, Clemmer TP, Horn SD, Weaver L, Handrahan D, Thomas F, Merrill S, Kitterman N, Yeates S. Calf-thigh sequential pneumatic compression compared with plantar venous pneumatic compression to prevent deep-vein thrombosis after non-lower extremity trauma. J Trauma. 1999;47:25–31.CrossRefGoogle Scholar
  52. 52.
    Robertson KA, Bertot AJ, Wolfe MW, Barrack RL. Patient compliance and satisfaction with mechanical devices for preventing deep venous thrombosis after joint replacement. J South Orthop Assoc. 2000;9(3):182–6.PubMedGoogle Scholar
  53. 53.
    Westrich GH, Specht LM, Sharrock NE, Windsor RE, Sculco TP, Haas SB, Trombley JF, Peterson M. Venous haemodynamics after total knee arthroplasty. Evaluation of active dorsal to plantar flexion and several mechanical devices. J Bone Joint Surg Br. 1998;80B:1057–106.CrossRefGoogle Scholar
  54. 54.
    Fuchs S, Heyse T, Rudolfsky G, Gosheger G, Chylarecki C. Continuous passive motion in the prevention of deep vein thrombosis. J Bone Joint Surg Br. 2005;87B:1117–22.Google Scholar
  55. 55.
    Hills NH, Pflug JJ, Jeyasingh K, Boardman L, Calnan JS. Prevention of deep vein thrombosis by intermittent pneumatic compression of calf. BMJ. 1972;1:131–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Cotton LT. Intermittent compression of the legs during operation as a method of prevention of deep vein thrombosis. Proc R Soc Med. 1974;67:708.PubMedGoogle Scholar
  57. 57.
    Dai G, Gertler JP, Kamm RD. The effects of external compression on venous blood flow and tissue deformation in the lower leg. J Biomech Eng. 1999;121:557–64.PubMedCrossRefGoogle Scholar
  58. 58.
    Keith SL, McLaughlin DJ, Anderson Jr FA, Cardullo PA. Do graduated compression stockings and pneumatic boots have an additive effect on the peak velocity of venous blood flow? Arch Surg. 1992;127:727–30.PubMedCrossRefGoogle Scholar
  59. 59.
    Warwick DJ, Dewbury K. A novel approach to mechanical prophylaxis: calf impulse technology mimics natural ambulation more effectively than sequential calf compression. Int J Angiol. 2008;17:197–201.PubMedCrossRefGoogle Scholar
  60. 60.
    Eisele R, Kinzle L, Koelsch T. Rapid-inflation intermittent compression for prevention of deep vein thrombosis. J Bone Joint Surg Am. 2007;89:1050–6.PubMedCrossRefGoogle Scholar
  61. 61.
    Merrett ND, Hanel KC. Ischaemic complications of graduated compression stockings in the treatment of deep venous thrombosis. Postgrad Med J. 1993;69:232–4.PubMedCrossRefGoogle Scholar
  62. 62.
    McGrory BJ, Burke DW. Peroneal nerve palsy following intermittent sequential pneumatic compression. Orthopedics. 2000;23:1103–5.PubMedGoogle Scholar
  63. 63.
    Hull R, Delmore TJ, Hirsh J, Gent M, Armstrong P, Lofthouse MMA, Blackstone I, Reed-Davis R, Detwiler RC. Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh vein thrombosis in patients undergoing elective knee replacement. Thromb Res. 1979;16:37–45.PubMedCrossRefGoogle Scholar
  64. 64.
    MacKenna R, Galante J, Bachmann F, Wallace DL, Kaushal SP, Meredith P. Prevention of venous thromboembolism after total knee replacement by high dose aspirin or intermittent calf and thigh compression. Br Med J. 1990;280:514–7.CrossRefGoogle Scholar
  65. 65.
    Lynch AF, Bourne RB, Rorabeck CH, Rankin RN, Donald A. Deep-vein thrombosis and continuous passive motion after total knee arthroplasty. J Bone Joint Surg Am. 1988;70:11–4.PubMedGoogle Scholar
  66. 66.
    Haas SB, Insall JN, Scuderi GR, Windsor RE, Ghelman B. Pneumatic sequential compression boots compared with aspirin prophylaxis of deep vein thrombosis after total knee arthroplasty. J Bone Joint Surg. 1990;72A:27–31.Google Scholar
  67. 67.
    Hartman JT, Pugh JL, Smith RD, Robertson WW, Yost RP, Janssen HF. Cyclic sequential compression of the lower limb in prevention of deep vein thrombosis. J Bone Joint Surg. 1982;64A:1059–62.Google Scholar
  68. 68.
    Gallus A, Raman K, Darby T. Venous thrombosis after elective hip replacement. The influence of preventive intermittent calf compression and of surgical technique. Br J Surg. 1993;70:17–9.CrossRefGoogle Scholar
  69. 69.
    Paiement G, Wessinger SJ, Waltman AC, Harris WH. Low-dose warfarin versus external pneumatic compression for prophylaxis against venous thromboembolism following total hip replacement. J Arthroplasty. 1987;2:23–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Hull RD, Rascob GE, Gent M, McLoughlin D, Julian D, Smithy FC, et al. Effectiveness of intermittent pneumatic compression for preventing deep vein thrombosis after total hip replacement. JAMA. 1990;263:2313–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Bailey JP, Kruger MP, Solano FX, Zajko AB, Rubash HE. Prospective randomised trial of sequential compression devices vs low-dose warfarin for deep venous thrombosis prophylaxis in hip arthroplasty. J Arthroplasty. 1991;6:S29–34.PubMedCrossRefGoogle Scholar
  72. 72.
    Kaempffe FA, Lifeso RM, Meinking C. Intermittent pneumatic compression versus coumadin. Clin Orthop. 1991;269:89–97.PubMedGoogle Scholar
  73. 73.
    Francis CW, Pellegrini VD, Marder VJ, Totterman S, Harris CM, Gabriel R, Azodo MV, Leibert KM. Comparison of warfarin and external pneumatic compression in prevention of venous thrombosis after total hip replacement. JAMA. 1992;67:2911–5.CrossRefGoogle Scholar
  74. 74.
    Vanek VW. Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves. Am Surg. 1998;64:1050–8.PubMedGoogle Scholar
  75. 75.
    Pitto RP, Hamer H, Kuhle JW, Radespiel-Troger M, Pietsch M. Haemodynamics of the lower extremity with pneumatic foot compression. Biomed Tech (Berl). 2001;46:124–8.CrossRefGoogle Scholar
  76. 76.
    Pitto RP, Young S. Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance. A comparative, prospective clinical trial. Int Orthop. 2008;32(3):331–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Anand S, Asumu T. Patient acceptance of a foot pump device used for thromboprophylaxis. Acta Orthop Belg. 2007;73:386–9.PubMedGoogle Scholar
  78. 78.
    Froimson MI, Murray TG, Fazekas AF. Venous thromboembolic disease reduction with a portable pneumatic compression device. J Arthroplasty. 2009;24:310–6.PubMedCrossRefGoogle Scholar
  79. 79.
    Wilson NV, Das SK, Kakkar VV, Maurice HD, Smibert JG, Thomas EM, Nixon JE. Thromboembolic prophylaxis in total knee replacement. J Bone Joint Surg. 1992;74B:50–2.Google Scholar
  80. 80.
    Norgren L, Toksvig-Larsen S, Magyar G, Lindstrand A, Albrechtsson U. Prevention of deep vein thrombosis in knee arthroplasty: preliminary results from a randomised controlled study of low molecular weight heparin vs foot pump compression. Int Angiol. 1998;17:93–6.PubMedGoogle Scholar
  81. 81.
    Blanchard J, Meuwly J-Y, Leyvraz P-F, Miron M-J, Bounameaux HP, Didier D, Schneider P-A. Prevention of deep vein thrombosis after total knee replacement. Randomised comparison between a low molecular weight heparin (nadroparin) and mechanical prophylaxis with a foot-pump system. J Bone Joint Surg. 1999;81B:654–9.CrossRefGoogle Scholar
  82. 82.
    Warwick D, Harrison J, Whitehouse S, Mitchelmore A, Thornton M. A randomized comparison of a foot pump and low molecular weight heparin in the prevention of deep vein thrombosis after total knee replacement. J Bone Joint Surg. 2002;84B:344–50.CrossRefGoogle Scholar
  83. 83.
    Bradley JG, Krugener GH, Jager HJ. The effectiveness of intermittent plantar venous compression in the prevention of deep venous thrombosis after total hip arthroplasty. J Arthroplasty. 1993;8:57–60.PubMedCrossRefGoogle Scholar
  84. 84.
    Fordyce M, Ling RSM. A venous foot pump reduces thrombosis after hip replacement. J Bone Joint Surg. 1992;74B:45–9.Google Scholar
  85. 85.
    Santori ES, Vitullo A, Stopponi M, Santori N, Ghera S. Prophylaxis against deep venous thrombosis in total hip replacement. J Bone Joint Surg Br. 1994;76B:579–83.Google Scholar
  86. 86.
    Warwick DJ, Harrison J, Glew D, Mitchelmore A, Peters T, Donovan J. Comparison of the use of a foot pump with the use of low molecular weight heparin for the prevention of deep vein thrombosis after total hip replacement. J Bone Joint Surg. 1998;80A:1158–66.Google Scholar
  87. 87.
    Pitto RP, Hamer H, Heiss-Dunlop W, Kuehle J. Mechanical prophylaxis of deep-vein thrombosis after total hip replacement a randomised clinical trial. J Bone Joint Surg Br. 2004;86:639–42.PubMedCrossRefGoogle Scholar
  88. 88.
    Stannard JP, Harris RM, Bucknell AL, Cossi A, Ward J, Arington ED. Prophylaxis of deep venous thrombosis after total hip arthroplasty by using intermittent compression of the plantar venous plexus. Am J Orthop. 1996;25:127–34.PubMedGoogle Scholar
  89. 89.
    Browse NL, Negus D. Prevention of postoperative leg vein thrombosis by electrical muscle stimulation. An evaluation with 125I-labelled fibrinogen. BMJ. 1970;3:615–8.PubMedCrossRefGoogle Scholar
  90. 90.
    Czyrny JJ, Kaplan RE, Wilding GE, Purdy CH, Hirsh J. Electrical foot stimulation: a potential new method of deep venous thrombosis prophylaxis. Vascular. 2010;18:20–7.PubMedCrossRefGoogle Scholar
  91. 91.
    Giannoudis PV, Pountos I, Pape HC, Patel JV. Safety and efficacy of vena cava filters in trauma patients. Injury Int J Care Injured. 2007;38:7–18.Google Scholar
  92. 92.
    Warwick DJ. New concepts in orthopaedic thromboprophylaxis. J Bone Joint Surg Br. 2004;86B:788–92.CrossRefGoogle Scholar
  93. 93.
    Warwick DJ, Dahl OE, Fisher WD. Orthopaedic thromboprophylaxis: limitations of current guidelines. J Bone Joint Surg Br. 2008;90-B:127–32.CrossRefGoogle Scholar
  94. 94.
    Stannard JP, Lopez RR, Volgas DA, Anderson ER, Busbee M, Karr DK, McGwin GR, Alonso JE. Prophylaxis against deep-vein thrombosis following trauma- a prospective randomized comparison of mechanical and pharmacologic prophylaxis. J Bone Joint Surg Am. 2006;88A:261–6.CrossRefGoogle Scholar
  95. 95.
    Eskander MB, Limb D, Stone MH, Furlong AJ, Shardlow D, Stead D, Culleton G. Sequential mechanical and pharmacological thromboprophylaxis in the surgery of hip fractures. A pilot study. Int Orthop. 1997;21(4):259–61.PubMedCrossRefGoogle Scholar
  96. 96.
    Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ. Combined intermittent pneumatic compression and pharmacological prophylaxis for prevention of venous thromboembolism in high risk patients (a review). Cochrane Database Syst Rev. 2008;(4):CD005258.Google Scholar
  97. 97.
    Silbersack Y, Taute BM, Hein W, Podhaisky H. Prevention of deep vein thrombosis after total hip and knee replacement. J Bone Joint Surg Br. 2004;86B:809–12.CrossRefGoogle Scholar
  98. 98.
    Westrich GH, Sculco TP. Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg Am. 1996;78-A:826–34.Google Scholar
  99. 99.
    Edwards JZ, Pulido PA, Ezzet KA, Copp SN, Walker RH, Colwell Jr CW. Portable compression device and low-molecular-weight heparin compared with low-molecular-weight heparin for thromboprophylaxis after total joint arthroplasty. J Arthroplasty. 2008;23:1122–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of SouthamptonSouthamptonUK

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