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L. Marin1,2,3, M. Chiodaroli2,4, F. de Caro5,4, E. Caldarella5, G. Arcuri2, M. Febbi3,4, M. Vandoni1, V. Carnevale Pellino6,1
1University of Pavia, Laboratory of Adapted Motor Activity (LAMA), Public Health, Experimental and Forensic Medicine, Pavia, Italy, 2Istituto di Cura Città di Pavia, University Hospital, Rehabilitation, Pavia, Italy, 3Asomi College of Sciences, Research, Malta, Malta, 4Laboratory for Rehabilitation, Medicine and Sport, Research, Rome, Italy, 5Istituto di Cura Città di Pavia, University Hospital, Orthopedic Surgery, Pavia, Italy, 6University of Tor Vergata, Industrial Engineering, Rome, Italy
Background: Patients undergoing total hip arthroplasty (THA) are at high risk of developing edema and deep venous thrombosis (DVT).
Pharmacological DVT prophylaxis after THA is universally done to prevent it. The results of few studies seem to highlight the effectiveness of pneumatic compression in the management of post-THA edema. Even anti-thromboembolic exercises have positive effects. This is why it is interesting to compare the effects of these two treatments on post-THA edema.
Pharmacological DVT prophylaxis after THA is universally done to prevent it. The results of few studies seem to highlight the effectiveness of pneumatic compression in the management of post-THA edema. Even anti-thromboembolic exercises have positive effects. This is why it is interesting to compare the effects of these two treatments on post-THA edema.
Purpose: The primary objective is to measure and compare the pre-post treatment dimensions of post-THA edema between the patients grouped in: pneumatic compression (PC), anti-thromboembolic exercises (AE) and control group (CG). Secondary objectives are to compare changes in functional and pain outcomes.
Methods: From 28th March to 26th July 2022 at the “Città di Pavia” University Hospital (Pavia, Italy), 39 patients undergoing THA with programmed hospitalization were recruited. Inclusion criteria were: ≤ 80 years, Body Mass Index < 30, absence of other pathologies that limited walking. On the first post-surgical day patients received an informative brochure on the study, they signed an informed consent and they were assigned by block randomization to one of the three study groups. No statistically significant differences were found between groups. The treatment lasted 10 sessions starting from the second post-THA day (T0).
Every day PC performed two 30-minute sessions of sequential pneumatic compression (I-Press, I-Tech Medical Division, Scorzè, Italy) while AE performed two supervised 30-minute sessions of anti-thromboembolic exercises. Everyone underwent DVT prophylaxis: drug therapy, graduated compression stocking and indirect electrostimulation (T-One Rehab, I-Tech Medical Division).
At T0 and the last day of treatment (T1), circumferences of the distal third of the thigh and the proximal third of the calf (centimeters) and active flexion range of motion of knee and ankle (degrees) were measured on the operated limb. The perceived pain was also assessed with the Numeric Rating Scale (0 up to 10) and walking autonomy with the 20-meter walk test (seconds). Only at T1 the Six minutes walking test (meters) was done. The statistical analysis was performed with Jamovi 1.0.8 software, using ANOVA with post-hoc Bonferroni correction. A pvalue ≤0.05 was considered as significant.
Every day PC performed two 30-minute sessions of sequential pneumatic compression (I-Press, I-Tech Medical Division, Scorzè, Italy) while AE performed two supervised 30-minute sessions of anti-thromboembolic exercises. Everyone underwent DVT prophylaxis: drug therapy, graduated compression stocking and indirect electrostimulation (T-One Rehab, I-Tech Medical Division).
At T0 and the last day of treatment (T1), circumferences of the distal third of the thigh and the proximal third of the calf (centimeters) and active flexion range of motion of knee and ankle (degrees) were measured on the operated limb. The perceived pain was also assessed with the Numeric Rating Scale (0 up to 10) and walking autonomy with the 20-meter walk test (seconds). Only at T1 the Six minutes walking test (meters) was done. The statistical analysis was performed with Jamovi 1.0.8 software, using ANOVA with post-hoc Bonferroni correction. A pvalue ≤0.05 was considered as significant.
Results: Compared to T0, at T1, the edema dimensions and the other outcomes, when compared with CG, improved more in AE and PC.
In particular, the decrease of the circumference of the distal third of the thigh was significant for both AE (-50 ± 13; p <0.001) and for PC (-24 ± 14.2; p <0.001). Values highlight pre-post differences and are expressed as mean and standard deviation. The results of the Six minutes walking test did not show significant differences neither between AE and PC nor with respect to CG.
In particular, the decrease of the circumference of the distal third of the thigh was significant for both AE (-50 ± 13; p <0.001) and for PC (-24 ± 14.2; p <0.001). Values highlight pre-post differences and are expressed as mean and standard deviation. The results of the Six minutes walking test did not show significant differences neither between AE and PC nor with respect to CG.
Conclusions: Post-THA pneumatic compression and anti-thromboembolic exercises would seem to be both effective in reducing edema and perceived pain and improving functional outcomes.
Implications: Both AE and PC are useful for the treatment of post-THA edema but PC, compared to AE, allows the physiotherapist to save a lot of time by improving the effectiveness of the treatment.
Funding acknowledgements: No Funding
Keywords:
Total Hip Arthroplasty
Edema
Physiotherapy treatment
Total Hip Arthroplasty
Edema
Physiotherapy treatment
Topics:
Orthopaedics
Musculoskeletal: lower limb
Innovative technology: information management, big data and artificial intelligence
Orthopaedics
Musculoskeletal: lower limb
Innovative technology: information management, big data and artificial intelligence
Did this work require ethics approval? Yes
Institution: Policlinico S. Matteo Foundation IRCCS
Committee: Ethics Committee Pavia
Ethics number: 0014626/22
All authors, affiliations and abstracts have been published as submitted.
