Portable compression device and low-molecular-weight heparin compared with low-molecular-weight heparin for thromboprophylaxis after total joint arthroplasty.

This preliminary prospective study to determine the rate of deep venous thrombosis (DVT) examined 277 patients undergoing total knee or total hip arthroplasty (TKA or THA) who were randomized to use a portable, continuous enhanced circulation therapy (CECT) compression device and low-molecular-weight heparin (LMWH) or to receive LMWH alone. Patients were screened for DVT using duplex ultrasound at hospital discharge and followed clinically for 3 months. In TKA, 5 DVTs (6.6%) occurred in the CECT + LMWH group compared with one pulmonary embolism and 14 DVTs (19.5%) in the LMWH group (P = .018). In THA, 1 DVT (1.5%) occurred in the CECT + LMWH group and 2 DVTs (3.4%) occurred in the LMWH group. This preliminary study demonstrated significant reduction in rate of DVT after TKA when the CECT device was combined with LMWH.

Measuring flexion in knee arthroplasty patients.

Flexion following total knee arthroplasty can be visually estimated, measured with a goniometer placed against the patient's leg, or measured from a lateral radiograph of the flexed knee. Three examiners, in a blinded fashion, estimated the degree of maximal knee flexion and measured the flexion with a goniometer for 27 knees in 16 patients. A lateral knee radiograph then was taken and the flexion angle was measured from the radiograph by 2 different methods. Although interobserver and intraobserver correlation coefficients were high (0.79 and 0.92), 45% of the visual estimates and 22% of the goniometer measurements differed by 5 degrees or greater from the radiographic measurements. These differences increased as the flexion angle increased. Body mass index did not affect the accuracy of the estimates or goniometer measurements.