The effects of intermittent pneumatic compression on DVT after Achilles rupture repair

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Dr. Paul Ackermann discusses the effect of intermittent pneumatic compression on DVT during postoperative lower limb immobilisation following Achilles tendon rupture.
One hundred and fifty patients who underwent Achilles tendon rupture repair surgery were randomized to receive either intermittent pneumatic compression (IPC) for six hours a day under an orthosis (Aircast XP Walker, DJO LLC) for two weeks, or standard treatment in a plaster cast without IPC. The purpose of this study was to determine the effects of IPC on rates of deep vein thrombosis (DVT.) The findings of this study demonstrated IPC to be an effective treatment to reduce incidence of DVT at two-weeks postoperatively compared to patients in a plaster cast without IPC. However, following the Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Stockholm County Council and Karolinska Institutet, the Swedish National Centre for Sports Research, Swedish Research Council, and a grant provided by DJO, Vista, California
Conflicts: None disclosed
Why was this study needed now?
Deep vein thrombosis (DVT) is a common postoperative complication that can result during immobilization of the lower limb. Intermittent pneumatic compression (IPC) therapy has been suggested to reduce the incidence of DVT in patients who have undergone acute Achilles tendon rupture repair surgery. Previous reviews have reported a decreased incidence of DVT in hospitalized arthroplasty patients and therefore, an interest has been shown to determine whether similar benefits apply in the current patient population.
What was the principal research question?
Does intermittent pneumatic compression therapy in outpatients who have undergone acute Achilles tendon rupture repair surgery reduce the incidence of deep vein thrombosis compared to the standard plaster cast without IPC, as assessed up to 6 weeks postoperatively?
Population: One hundred and fifty patients (between 18 and 75 years of age) who underwent surgery within 96 hours of their injury for acute unilateral ruptures of the Achilles tendon were included in this study. All patients were prescribed 500 mg of paracetamol or 30 mg of codeine if necessary; one to two pills for a maximum of four times were to be taken daily if needed. Additionally, after 2 weeks of treatment, all patients received a lower leg orthosis (Aircast XP Walker; DJO) and were instructed to start bearing weight fully.
Intervention: Adjuvant IPC group: patients received bilateral IPC of the calf while sedentary for a minimum of six hours daily for two weeks. After two weeks IPC was discontinued and all patients were immobilized in an orthosis for a further 4 weeks (n=74; 69 completed; Mean age: 40.7; 59M/10F)
Comparison: Plaster cast (control) group: a below-knee plaster cast was applied to patients shortly after surgical treatment. Patients were non-weight bearing and given crutches for two-weeks postoperatively. (n=74; 71 completed; Mean age: 39.9; 58M/13F)
Outcomes: The primary outcome in this study was the incidence of deep vein thrombosis which was assessed via compression duplex ultrasound.
Methods: RCT; prospective, single-blind
Time: Follow-up occurred at 2-weeks and 6-weeks postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.