We hypothesised that adjuvant intermittent pneumatic
compression (IPC) beneath a plaster cast would reduce the risk of
deep-vein thrombosis (DVT) during post-operative immobilisation
of the lower limb. Of 87 patients with acute tendo Achillis (TA)
rupture, 26 were prospectively randomised post-operatively after
open TA repair. The treatment group (n = 14) received two weeks of
IPC of the foot for at least six hours daily under a plaster cast.
The control group (n = 12) had no additional treatment. At two weeks
post-operatively all patients received an orthosis until follow-up
at six weeks. At two and six weeks the incidence of DVT was assessed
using colour duplex sonography by two ultrasonographers blinded
to the treatment. Two patients withdrew from the study due to inability
to tolerate IPC treatment. An interim analysis demonstrated a high incidence of DVT in both
the IPC group (9 of 12, 75%) and the controls (6 of 12, 50%) (p
= 0.18). No significant differences in incidence were detected at
two (p = 0.33) or six weeks (p = 0.08) post-operatively. Malfunction
of the IPC leading to a second plaster cast was found to correlate
with an increased DVT risk at two weeks (φ = 0.71; p = 0.019), leading
to a premature abandonment of the study. We cannot recommend adjuvant treatment with foot IPC under a
plaster cast for outpatient DVT prevention during post-operative
immobilisation, owing to a high incidence of DVT related to malfunctioning
of this type of IPC application. Cite this article:
The results of primary total knee replacement performed on a group of haemophiliac patients in a single institution by the same surgeon using the same surgical technique and prosthesis are reported. A total of 35 primary replacements in 30 patients were carried out between 1996 and 2005 and were reviewed retrospectively. The mean age of the patients was 31 years (24 to 42) and the mean follow-up was for 7.5 years (1 to 10). There were 25 patients with haemophilia A and five with haemophilia B. The HIV status and CD4 count were recorded, and Knee Society scores determined. Two patients had inhibitors to the deficient coagulation factor. There were no early wound infections and only one late deep infection which required a two-stage revision arthroplasty, with a good final result. The incidence of infection in HIV-positive and negative patients was thus similar. One knee in a patient with inhibitor had excessive bleeding due to a pseudoaneurysm which required embolisation. The results were excellent in 27 knees (77%), good in six (17%) and fair in two (6%). The survival rate at 7.5 years taking removal of the prosthesis for loosening or infection as the end-point was 97%. The mechanical survival of total knee replacements in haemophiliacs is very good. Our results confirm that this is a reproducible procedure in haemophilia, even in HIV-positive patients with a CD4 count >
200 mm3 and those with inhibitors. Our rate of infection was lower than previously reported. This could be due to better control of the HIV status with highly active anti-retroviral therapy and the use of antibiotic-loaded cement.
