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Scientific Articles   |    
A Mobile Compression Device for Thrombosis Prevention in Hip and Knee Arthroplasty
Clifford W. Colwell, Jr., MD1; Mark I. Froimson, MD2; Scott D. Anseth, MD3; Nicholas J. Giori, MD, PhD4; William G. Hamilton, MD5; Robert L. Barrack, MD6; Knute C. Buehler, MD7; Michael A. Mont, MD8; Douglas E. Padgett, MD9; Pamela A. Pulido, BSN1; C. Lowery Barnes, MD10
1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 200, La Jolla, CA 92037. E-mail address for C.W. Colwell Jr.: colwell@scripps.edu
2 Euclid Cleveland Clinic, Euclid Hospital – Administration, 18901 Lake Shore Boulevard, Euclid, OH 44119
3 Twin Cities Orthopaedics, 4010 West 65th Street, Edina, MN 55435
4 VA Palo Alto Health Care System, 3801 Miranda Avenue (112), Palo Alto, CA 94304
5 Anderson Orthopaedic Clinic, 2501 Parkers Lane, Alexandria, VA 22306
6 Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110
7 The Center, Orthopedic & Neurosurgical Care & Research, 2200 N.E. Neff Road, Suite 200, Bend, OR 977041-4281
8 Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215
9 Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021-4892
10 Arkansas Specialty Orthopaedics, 1701 Aldersgate Road, Suite 3, Little Rock, AR 72205
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  • Disclosure statement for author(s): PDF

Investigation performed at the Scripps Clinic, La Jolla, California; Cleveland Clinic, Cleveland, Ohio; Twin Cities Orthopaedics, Edina, Minnesota; VA Palo Alto Health Care System, Palo Alto, California; Anderson Orthopaedic Clinic, Alexandria, Virginia; Washington University School of Medicine, St. Louis, Missouri; The Center, Orthopedic & Neurosurgical Care & Research, Bend, Oregon; Rubin Institute for Advanced Orthopedics, Baltimore, Maryland; Hospital for Special Surgery, New York, NY; and Arkansas Specialty Orthopaedics, Little Rock, Arkansas

A commentary by Piers Yates, MBBS(Hons), BSc(Hons), MRCS(Eng), FRCS(Tr&Orth), FRACS(Ortho), FAOrthA, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Feb 05;96(3):177-183. doi: 10.2106/JBJS.L.01031
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Abstract

Background: 

Venous thromboembolic events, either deep venous thrombosis or pulmonary embolism, are important complications in patients undergoing knee or hip arthroplasty. The purpose of this study was to evaluate the effectiveness of a mobile compression device (ActiveCare+S.F.T.) with or without aspirin compared with current pharmacological protocols for prophylaxis against venous thromboembolism in patients undergoing elective primary unilateral arthroplasty of a lower-extremity joint.

Methods: 

A multicenter registry was established to capture the rate of symptomatic venous thromboembolic events following primary knee arthroplasty (1551 patients) or hip arthroplasty (1509 patients) from ten sites. All patients were eighteen years of age or older with no known history of venous thromboembolism, coagulation disorder, or solid tumor. Use of the compression device began perioperatively and continued for a minimum of ten days. Patients with symptoms of deep venous thrombosis or pulmonary embolism underwent duplex ultrasonography and/or spiral computed tomography. All patients were evaluated at three months postoperatively to document any evidence of deep venous thrombosis or pulmonary embolism.

Results: 

Of 3060 patients, twenty-eight (0.92%) had venous thromboembolism (twenty distal deep venous thrombi, three proximal deep venous thrombi, and five pulmonary emboli). One death occurred, with no autopsy performed. Symptomatic venous thromboembolic rates observed in patients who had an arthroplasty of a lower-extremity joint using the mobile compression device were noninferior (not worse than), at a margin of 1.0%, to the rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran, except in the knee arthroplasty group, in which the mobile compression device fell short of the rate reported for rivaroxaban by 0.06%.

Conclusions: 

Use of the mobile compression device with or without aspirin for patients undergoing arthroplasty of a lower-extremity joint provides a noninferior risk for the development of venous thromboembolism compared with current pharmacological protocols.

Level of Evidence: 

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Peer Review 

This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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