Haemodynamic performance of neuromuscular electrical stimulation (NMES) during recovery from total hip arthroplasty

Barry J Broderick, Oisin Breathnach, Finbarr Condon, Eric Masterson, Gearóid Ólaighin, Barry J Broderick, Oisin Breathnach, Finbarr Condon, Eric Masterson, Gearóid Ólaighin

Abstract

Background: Patients post total hip arthroplasty (THA) remain at high risk of developing Deep Vein Thrombosis (DVT) during the recovery period following surgery despite the availability of effective pharmacological and mechanical prophylactic methods. The use of calf muscle neuromuscular electrical stimulation (NMES) during the hospitalised recovery period on this patient group may be effective at preventing DVT. However, the haemodynamic effectiveness and comfort characteristics of NMES in post-THA patients immediately following surgery have yet to be established.

Methods: The popliteal veins of 11 patients, who had undergone unilateral total hip replacement surgery on the day previous to the study, were measured using Doppler ultrasound during a 4 hour neuromuscular electrical stimulation (NMES) session of the calf muscles. The effect of calf muscle NMES on peak venous velocity, mean venous velocity and volume flow were compared to resting values. Comfort was assessed using a 100mm non-hatched visual analogue scale taken before application of NMES, once NMES was initiated and before NMES was withdrawn.

Results: In the operated limb NMES produced increases in peak venous velocity of 99% compared to resting. Mean velocity increased by 178% compared to resting and volume flow increased by 159% compared to resting. In the un-operated limb, peak venous velocity increased by 288%, mean velocity increased by 354% and volume flow increased by 614% compared to basal flow (p<0.05 in all cases). There were no significant differences observed between the VAS scores taken before the application of NMES, once NMES was initiated and before NMES was withdrawn (p=.211).

Conclusions: NMES produces a beneficial hemodynamic response in patients in the early post-operative period following orthopaedic surgery. This patient group found extended periods of calf-muscle NMES tolerable.

Trial registration: ClinicalTrials.gov NCT01785251.

Figures

Figure 1
Figure 1
An illustration of the posterior aspect of the legs showing the position of the two NMES electrodes placed over the soleus muscles of both legs.
Figure 2
Figure 2
A screenshot of the Doppler machine showing baseline blood flow followed by NMES elicited blood flow.
Figure 3
Figure 3
Peak venous blood flow velocity measurements due to the NMES elicited calf muscle contraction versus resting in the operated limb and un-operated limb (* P

Figure 4

Time average mean velocity measurements…

Figure 4

Time average mean velocity measurements due to the NMES elicited calf muscle contraction…

Figure 4
Time average mean velocity measurements due to the NMES elicited calf muscle contraction versus resting in the operated limb and un-operated limb (* P

Figure 5

Volume flow measurements due to…

Figure 5

Volume flow measurements due to the elicited calf muscle contraction versus resting in…

Figure 5
Volume flow measurements due to the elicited calf muscle contraction versus resting in the operated limb and un-operated limb (* P

Figure 6

Mean VAS scores for all…

Figure 6

Mean VAS scores for all patients (n=11) at baseline, when NMES was started…

Figure 6
Mean VAS scores for all patients (n=11) at baseline, when NMES was started and just before NMES was finished (error bars indicate SEM).
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References
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Figure 4
Figure 4
Time average mean velocity measurements due to the NMES elicited calf muscle contraction versus resting in the operated limb and un-operated limb (* P

Figure 5

Volume flow measurements due to…

Figure 5

Volume flow measurements due to the elicited calf muscle contraction versus resting in…

Figure 5
Volume flow measurements due to the elicited calf muscle contraction versus resting in the operated limb and un-operated limb (* P

Figure 6

Mean VAS scores for all…

Figure 6

Mean VAS scores for all patients (n=11) at baseline, when NMES was started…

Figure 6
Mean VAS scores for all patients (n=11) at baseline, when NMES was started and just before NMES was finished (error bars indicate SEM).
Similar articles
Cited by
References
    1. White R. The epidemiology of venous thromboembolism. Circulation. 2003;107(90231):I-4–I-8. - PubMed
    1. Illingworth C, Timmons S. An audit of intermittent pneumatic compression (IPC) in the prophylaxis of asymptomatic deep vein thrombosis (DVT) J Perioper Pract. 2007;17(11):522–524. - PubMed
    1. MacLellan DG, Fletcher JP. Mechanical compression in the prophylaxis of venous thromboembolism. ANZ J Surg. 2007;77(6):418–423. doi: 10.1111/j.1445-2197.2007.04085.x. - DOI - PubMed
    1. Prandoni P, Lensing AW, Prins MR. Long-term outcomes after deep venous thrombosis of the lower extremities. Vasc Med. 1998;3(1):57–60. - PubMed
    1. Autar R. NICE guidelines on reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients undergoing surgery. J Orthop Nurs. 2007;11(3–4):169–176.
Show all 31 references
Publication types
MeSH terms
Associated data
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 5
Figure 5
Volume flow measurements due to the elicited calf muscle contraction versus resting in the operated limb and un-operated limb (* P

Figure 6

Mean VAS scores for all…

Figure 6

Mean VAS scores for all patients (n=11) at baseline, when NMES was started…

Figure 6
Mean VAS scores for all patients (n=11) at baseline, when NMES was started and just before NMES was finished (error bars indicate SEM).
Figure 6
Figure 6
Mean VAS scores for all patients (n=11) at baseline, when NMES was started and just before NMES was finished (error bars indicate SEM).

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