Mechanical calf compression and aspirin prophylaxis for total knee arthroplasty

We used aspirin and mechanical calf pneumatic compression for thromboembolism prophylaxis in 856 consecutive primary and revision total knee arthroplasties. Regional anesthesia was used in 97% of the procedures. Duplex ultrasonography was performed before discharge. We advised patients with calf thrombi to continue aspirin and have repeat duplex scans in 7 to 10 days. Patients with popliteal or femoral thrombi were given low-molecular-weight heparin and warfarin for 6 weeks. Using this protocol, the 90-day mortality rate was 0.14%. There was one fatal myocardial infarction. Three patients developed symptomatic nonfatal pulmonary embolisms, two occurring early and one late. Deep vein thrombosis occurred in 56 patients (9.3%). Only nine patients (1.5%) had symptomatic thrombosis, with four ipsilateral calf and five ipsilateral proximal thrombi. The data confirm the efficacy of a multimodal protocol with calf mechanical prophylaxis for almost all patients undergoing primary or revision total knee arthroplasty.