Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance

Mechanical prophylaxis with foot pumps provides an interesting alternative to chemical agents in the prevention of thromboembolic disease following major orthopaedic surgical procedures. Recent studies have suggested that the simultaneous use of graduated compression stockings (GCS) may hinder the pneumatic compression effect of foot pumps. The hypothesis of this prospective study was that the use of foot pumps without GCS does not affect the efficacy of deep-vein thrombosis (DVT) prophylaxis and improves patient compliance. A total of 846 consecutive patients admitted at a single institution undergoing total hip (THR) or knee replacement (TKR) were included in the study. The A-V Impulse System foot-pump unit (Orthofix Vascular Novamedix, Andover, UK) was used in all patients. Of these 846 patients, 46 discontinued the use of foot pumps, leaving 400 patients who received foot pumps in combination with GCS and 400 patients with foot pumps alone. Eleven patients of the stocking group (2.7%) and nine patients of the no-stocking group (2.3%) developed postoperative symptomatic DVT (p = 0.07). DVT was more frequent in TKR (10/364; 2.7%) than in THR (10/436; 2.3%). Non-fatal pulmonary embolism occurred in four of the 20 patients with symptomatic DVT, two patients each of the stocking and no-stocking groups. The foot-pump discontinuation rate of patients treated with stockings was 7% versus 4% of the patients treated without stockings (p < 0.05). In conclusion, management of patients with foot pumps without GCS does not reduce the efficacy of DVT prophylaxis after THR and TKR and improves patient compliance.