Clinical Investigation of a Novel Approach for the Prevention of Deep Venous Thrombosis After Total Knee Replacement
Venous thromboembolism, including deep vein thrombosis (DVT), has long been recognized as the most frequent complication within 7 to 14 days after orthopedic surgery, especially total joint arthroplasty. Without prophylactic therapy, the incidence of DVT and pulmonary embolism reaches up to 60% following orthopedic surgery. The possible damage to the vessel wall during the operation, the venous stasis caused by long-term bed rest, and the hypercoagulability of the blood after the surgery are the 3 main reasons for the formation of DVT. In most cases, the thrombi resolve spontaneously; however, some of them (about 1~4%) may develop into symptomatic and even fatal DVT.
Ankle pumping exercise is currently suggested for the patients with joint placement surgery to prevent the formation of lower-extremity DVT after orthopedic surgery. However, the compliance of the exercise at home is unclear. In order to remind the patients to the active ankle exercise and record the executive rate, a device was developed to help the patient to exercise in the hospital and at home. The device will remind the patient to exercise at specific time point by verbal and vibrations, and detect the range of motion during the exercise for further analysis. The aim of this study is to access the effect of a non-invasive novel device in preventing the formation of lower limb DVT. Maximum venous outflow, maximum venous capacity, and blood rheology were measured and the incidence of DVT was recorded for the data analysis.
調査の概要
状態
条件
詳細な説明
Background. Deep vein thrombosis (DVT) has long been recognized as the most frequent complication that occurs 7-14 days after total knee replacement (TKR). Physical therapy, including active ankle pumping exercises and intermittent pneumatic compression, is suggested for the prevention of DVT. However, the exercise implementation rate is not clear, particularly at home. In order to remind the patients to exercise after TKR, a watch with voice and vibration alarms at the set time was used.
Objective The first aim of this study was to compare the effect of active ankle movement with and without reminders on the prevention of DVT. The second aim was to compare the difference in the effect of intermittent pneumatic compression and active ankle movement on the prevention of DVT.
Design. A Pilot Randomized Controlled Trial Methods. The patients were divided into three groups according to the therapeutic protocols. The patients in group 1 conducted active ankle pumping without any reminders, those in group 2 underwent intermittent pneumatic compression, and those in group 3 conducted active ankle pumping with a regular watch alarm. The parameters of blood flow, namely peak flow velocity and flow volume, in the bilateral common femoral vein and popliteal vein on the 1st, 3rd, and 14th days after surgery were measured using the echo technique, as an index to evaluate the effect of DVT prevention among the three groups.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Changhua、台湾、500
- Show Chwan Memorial Hospital
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- patients who underwent total knee replacement surgery
Exclusion Criteria:
- Patients with a history of cardiovascular disease, such as DVT, dyslipidemia, hypertension, myocardial infarction, and hemorrhagic disease were excluded from this study.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:防止
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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介入なし:active ankle pumping without any reminders
In group 1, active ankle pumping exercise for the operative limb was performed without any reminder during hospitalization and at home after being discharged.
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アクティブコンパレータ:intermittent pneumatic compression
In group 2, intermittent pneumatic compression was applied to the operative low limb during hospitalization, while active ankle pumping exercise was adopted without any reminder after discharge.
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In this group, intermittent pneumatic compression was applied to the operative low limb during hospitalization, while active ankle pumping exercise was adopted without any reminder after discharge.
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実験的:active ankle pumping with a regular watch alarm
In group 3, in addition to the active ankle pumping exercise for the operative limb, the patients were reminded to exercise at specific time points with a vocal alarm and vibration through a wrist watch during the hospitalization period and at home after discharge.
The watch was continuously used until the 14th day when the patients returned to the hospital for examination.
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In addition to the active ankle pumping exercise for the operative limb, the patients were reminded to exercise at specific time points with a vocal alarm and vibration through a wrist watch during the hospitalization period and at home after discharge.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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change of peak flow velocity
時間枠:The peak flow velocity was determined on the 1st, 3rd, and 14th days after surgery.
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The peak flow velocity was directly detected using the Doppler images.
The examination was conducted by an experienced technician.
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The peak flow velocity was determined on the 1st, 3rd, and 14th days after surgery.
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change of flow volume
時間枠:The flow volume was determined on the 1st, 3rd, and 14th days after surgery.
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The flow volume was directly detected using the Doppler images.
The examination was conducted by an experienced technician.
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The flow volume was determined on the 1st, 3rd, and 14th days after surgery.
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Number of Participants with stasis
時間枠:Stasis was determined on the 1st, 3rd, and 14th days after surgery.
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Venous stasis was determined by a peak flow velocity lower than 10 cm/s, and the color of the blood inside the vein represented in the echo image was gray.
In addition, the contour of the vein was compressible under a slight compression force with an echo transducer.
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Stasis was determined on the 1st, 3rd, and 14th days after surgery.
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Number of Participants with deep venous thrombosis
時間枠:Deep venous thrombosis was determined on the 1st, 3rd, and 14th days after surgery.
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If the peak blood flow, flow volume, and blood echo image were the same as that of stasis, but the contour of the vein was incompressible under a slight compression, the cases were recorded as deep venous thrombosis.
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Deep venous thrombosis was determined on the 1st, 3rd, and 14th days after surgery.
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協力者と研究者
出版物と役立つリンク
一般刊行物
- Anderson DR, Dunbar M, Murnaghan J, Kahn SR, Gross P, Forsythe M, Pelet S, Fisher W, Belzile E, Dolan S, Crowther M, Bohm E, MacDonald SJ, Gofton W, Kim P, Zukor D, Pleasance S, Andreou P, Doucette S, Theriault C, Abianui A, Carrier M, Kovacs MJ, Rodger MA, Coyle D, Wells PS, Vendittoli PA. Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. N Engl J Med. 2018 Feb 22;378(8):699-707. doi: 10.1056/NEJMoa1712746.
- Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010 Jan;18(1):24-33. doi: 10.1016/j.joca.2009.08.010. Epub 2009 Sep 2.
- Boylan MR, Perfetti DC, Kapadia BH, Delanois RE, Paulino CB, Mont MA. Venous Thromboembolic Disease in Revision vs Primary Total Knee Arthroplasty. J Arthroplasty. 2017 Jun;32(6):1996-1999. doi: 10.1016/j.arth.2016.12.051. Epub 2017 Jan 11.
- Changulani M, Kalairajah Y, Peel T, Field RE. The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br. 2008 Mar;90(3):360-3. doi: 10.1302/0301-620X.90B3.19782.
- Chen Q, Huang S, Chen X, Feng L, Zhu X. [Clinical efficacy of multi-pattern detumescence after total knee arthroplasty treated with acupoint massage and mild moxibustion]. Zhongguo Zhen Jiu. 2016 May;36(5):471-5. Chinese.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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intermittent pneumatic compressionの臨床試験
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novoGI完了リンパ腫 | 結腸直腸腫瘍 | 子宮内膜症 | クローン病 | 大腸炎、潰瘍性 | 腸ポリポーシス | イレオストミー - ストーマ | 腸捻転 | コロストミー | 憩室、結腸 | 直腸脱アメリカ
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Calvary Hospital, Bronx, NYNew York State Department of Health; RTS Family Foundation完了
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Spaulding Rehabilitation HospitalFoundation Wings For Life積極的、募集していない
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Advanced Circulatory SystemsNational Heart, Lung, and Blood Institute (NHLBI)完了