Scripps Study Could Alter Treatment After Lower Joint Replacement Surgery

Study indicates mobile compression device safer than anticoagulant medication following hip arthroplasty

La Jolla – A study led by Scripps orthopedic researcher Clifford W. Colwell, Jr., MD, provides much-needed evidence to support a safer alternative for the prevention of venous thromboembolism (VTE) following lower-extremity joint replacement surgery.

The national, multicenter, randomized study compared two methods of VTE prophylaxis after total hip arthroplasty: a mobile compression device, which fits around the calf and enhances circulation; and low-molecular-weight heparin, a medication that’s administered by injection to prevent blood coagulation.

Results of the study, published as the feature article in The Journal of Bone & Joint Surgery’s March issue, show the major bleeding rate was zero percent among the 198 patients in the compression group and 5.6 percent among the 194 patients in the low-molecular-weight heparin group.

Major bleeding is the biggest risk associated with the use of low-molecular-weight heparin for VTE prevention. The complication can lead to blood transfusion, wound healing problems, hematomas, slowed rehabilitation, wound drainage and infection.

“Our study showed that a mobile compression device is safer than low-molecular-weight heparin with respect to major bleeding after total hip arthroplasty,” said Dr. Colwell.

VTE is a condition in which a blood clot forms in a vein. It consists of two potentially life–threatening conditions: deep venous thrombosis (DVT) and pulmonary embolism (PE). DVT and PE affect an estimated 350,000 to 600,000 Americans each year and contribute to at least 100,000 deaths, according to the U.S. Department of Health and Human Services. Without prophylaxis, the rate of deep venous thrombosis after total hip arthroplasty is as high as 50 percent.

“VTE poses a major public health problem and it is a vexing issue for orthopedic surgeons and their patients,” said Dr. Colwell, founder and medical director of the Shiley Center for Orthopaedic Research and Education at Scripps Clinic. “Those facts fueled our efforts to test the safety of a different approach.”

Prevention of blood clots has become a standard of care after joint replacement – a procedure that’s becoming more popular as a wave of aging baby boomers reach their golden years. In fact, demand for total knee replacements in the U.S. is predicted to grow by 673 percent – reaching 3.48 million – by the year 2030. Hip arthroplasty is expected to increase by 174 percent to 572,000.

“Considering the magnitude of the problem, more studies need to be done to test the efficacy of mobile compression devices in the prevention of DVT and PE,” said Dr. Colwell. “There is potential here to make post-surgical VTE prevention safer for a growing population of patients.”

A video supplement to the study, produced in conjunction with the Video Journal of Orthopaedics and the JBJS, is not available at this time.

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