The Compression recommendation has been downgraded two levels because of inconsistent evidence.
Three high quality studies (Grubhofer 2018, Snyder 2017, Pornrattanamaneewong 2019) and two moderate quality (Windisch 2011, Pornrattanamaneewong 2018) were evaluated with inconsistent results. In most cases, compression versus standard care showed no significant differences for pain or function. In one study, prolonged use of compression for six weeks had improved VAS and decreased DVT rate. A separate study had decreased opioid use on post-operative day one with compression.
Benefits/Harms of Implementation
Overall, effect size is limited with these studies, however the low cost and risk to the patient of compression weigh positively in considering use of this physical treatment. A decreased rate of DVT could have a benefit to the patient.
Cost Effectiveness/Resource Utilization
Use of compression in these studies required a specific machine which itself would be a large cost if a treating facility had not already invested in these devices. Otherwise, resource utilization is low.
Acceptability
Compression is already widely used in hospitals and would have no concerns with acceptability.
Feasibility
Compression is already widely used in hospitals and would have no concerns with feasibility. For an extended use of compression (after discharge), feasibility would be more challenging to gain resources from payers to distribute portable devices.
Future Research
Increased studies with larger patient populations evaluating compression with better examination of pain and opioid consumption after these interventions, better examination of functional scores and outcomes after this intervention.
- Grubhofer, F., Catanzaro, S., Schupbach, R., Imam, M. A., Wirth, S. Compressive Stockings After Hindfoot and Ankle Surgery. Foot Ankle Int 2018; 2: 210-218
- Pornrattanamaneewong, C., Ruangsomboon, P., Chareancholvanich, K., Wilairatana, V., Narkbunnam, R. Modified Robert Jones bandage can not reduce invisible blood loss after total knee arthroplasty: a randomized-controlled trial. Arch Orthop Trauma Surg 2018; 8: 1151-1157
- Pornrattanamaneewong, C., Ruangsomboon, P., Narkbunnam, R., Chareancholvanich, K., Wilairatana, V. The modified robert jones bandage does not improve performance or functional outcome after total knee arthroplasty: A randomized controlled trial. Journal of the Medical Association of Thailand 2019; 3: 355-360
- Snyder, M. A., Sympson, A. N., Scheuerman, C. M., Gregg, J. L., Hussain, L. R. Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial. J Arthroplasty 2017; 5: 1478-1482
- Windisch, C., Kolb, W., Kolb, K., Grutzner, P., Venbrocks, R., Anders, J. Pneumatic compression with foot pumps facilitates early postoperative mobilisation in total knee arthroplasty. Int Orthop 2011; 7: 995-1000