Pneumatic Compression Versus Anti-thromboembolic Exercises for Patients Undergoing Total Hip Arthroplasty

NCT ID: NCT05312060

Last Updated: 2022-05-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-04-11

Study Completion Date

2022-09-30

Brief Summary

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This study is a randomized controlled trial, with two parallel arms. The open-label study will be conducted in accordance with the helsinky statement and good clinical practice standards.

The main objective is to compare the reduction of postoperative edema following Total Hip Arthroplasty (THA) between patients undergoing postoperative treatment with pneumatic compression (PC, experimental group) and patients undergoing postoperative treatment with antithromboembolic exercises. (AE, control group). We also aim to compare the pre-post treatment variations of joint function measurements (joint excursion), referred pain and functional capabilities.

48 patients will meet the criteria listed below will be recruited.

Inclusion criteria:

* total hip arthroplasty under election regime
* aged between 50 and 80 at the time of recruitment, both sexes.

Exclusion criteria:

* obesity (BMI\> 30);
* other orthopedic or neurological pathologies that modify walking ability;
* pathologies that modify balance (neurological and / or vestibular);
* contraindications to the use of the medical equipment used in the study;
* inability to understand and sign informed consent. Participants will be assigned, through a block randomization, to one of the two study groups: experimental group will undergo pneumatic compression treatment (PC), control group will perform antithromboembolic exercises (AE).

For both, the treatment will last 10 working days, starting from the first post surgery day (T0). The PC will undergo two daily 30-minute sessions of sequential pneumatic compression (I-Press®, I-Tech Medical Division, Martellago, Italy) while AE will perform two supervised antithromboembolic exercises sessions daily lasting 30 minutes. All participants will carry out the antithrombotic prophylaxis in use at the department of orthopedics: drug therapy, graduated compression stocking and indirect electrostimulation (T-One Rehab®, I-Tech Medical Division, Martellago, Italy).

Assessments of edema, joint range of motion, pain and functional capabilities will be made at T0 and at the end of the treatment (T1).

Detailed Description

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This study is a randomized controlled trial, with two parallel arms. The open-label study will be conducted in accordance with the helsinky statement and good clinical practice standards.

To compare the reduction of postoperative edema following Total Hip Arthroplasty (THA) between patients undergoing postoperative treatment with pneumatic compression (PC, experimental group) and patients undergoing postoperative treatment with antithromboembolic exercises. (AE, control group). We also aim to compare the pre-post treatment variations of joint function measurements (joint excursion), referred pain and functional capabilities.

48 patients will be recruited at the Department of Orthopedic Surgery of the City of Pavia, University Hospital.

Participants will be assigned, through a block randomization, to one of the two study groups: experimental group will undergo pneumatic compression treatment (PC), control group will perform antithromboembolic exercises (AE). For both, the treatment will last 10 working days, starting from the first post surgery day (T0). The PC will undergo two daily 30-minute sessions of sequential pneumatic compression (I-Press®, I-Tech Medical Division, Martellago, Italy) while AE will perform two supervised antithromboembolic exercises sessions daily lasting 30 minutes. All participants will carry out the antithrombotic prophylaxis in use at the department of orthopedics: drug therapy, graduated compression stocking and indirect electrostimulation (T-One Rehab®, I-Tech Medical Division, Martellago, Italy).

At T0 and at the end of the treatment (T1) the following assessments of the operated limb will be carried out:

* circumference of the distal third of the thigh
* circumference of the proximal third of the leg
* range of motion of the knee flexion
* range of motion of the ankle dorsiflexion

The following assessments will also be carried out:

* perceived pain, with the Numeric Rating Scale of Pain (NRS)
* functional capability, with 20 m walk test (20 m). Walking autonomy will be carried out at T1 with the 6 minutes walking test (6MWT).

STATISTICAL ANALYSIS Quantitative variables will be described with mean and standard deviation if normally distributed, with median and interquartile range if not normally distributed.

Categorical variables will be expressed with counts and percentages. Continuous variables will be compared between the two groups with Student's t test or with the analogous non-parametric Mann-Whitney test, considering the normality of the distribution (evaluated with graphical methods or with the Shapiro-Wilk test).

Possible associations between categorical variables will be evaluated with Pearson's chi-square test or with Fisher's exact test.

All tests will be two-tailed; the level of significance is set at alpha 0.05 (statistical significance if p value \<0.05).

Conditions

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Edema Leg

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Pneumatic Compression (PC)

The PC will undergo two daily 30-minute sessions of sequential pneumatic compression.

Group Type EXPERIMENTAL

PC Pneumatic compression

Intervention Type DEVICE

Pneumatic compression of the operated limb

Antithromboembolic exercises (AE)

AE will perform two supervised antithromboembolic exercises sessions daily lasting 30 minutes.

Group Type ACTIVE_COMPARATOR

AE Antithromboembolic exercises

Intervention Type OTHER

Exercises for the edema

Interventions

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PC Pneumatic compression

Pneumatic compression of the operated limb

Intervention Type DEVICE

AE Antithromboembolic exercises

Exercises for the edema

Intervention Type OTHER

Other Intervention Names

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I-Press®, I-Tech Medical Division, Martellago, Italy

Eligibility Criteria

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Inclusion Criteria

* total hip arthroplasty, scheduled surgery
* aged between 50 and 80 at the time of recruitment

Exclusion Criteria

* obesity (BMI\> 30);
* other orthopedic or neurological pathologies that modify walking ability;
* pathologies that modify balance (neurological and / or vestibular);
* contraindications to the use of the medical equipment used in the study;
* inability to understand and sign informed consent.
Minimum Eligible Age

50 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Luca Marin

OTHER

Sponsor Role lead

Responsible Party

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Luca Marin

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Luca Marin, PhD

Role: PRINCIPAL_INVESTIGATOR

University fo Pavia

Locations

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Istituto di Cura Città di Pavia

Pavia, , Italy

Site Status

Countries

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Italy

References

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Santana DC, Emara AK, Orr MN, Klika AK, Higuera CA, Krebs VE, Molloy RM, Piuzzi NS. An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020. Medicina (Kaunas). 2020 Aug 19;56(9):416. doi: 10.3390/medicina56090416.

Reference Type BACKGROUND
PMID: 32824931 (View on PubMed)

O'Reilly RF, Burgess IA, Zicat B. The prevalence of venous thromboembolism after hip and knee replacement surgery. Med J Aust. 2005 Feb 21;182(4):154-9. doi: 10.5694/j.1326-5377.2005.tb06643.x.

Reference Type BACKGROUND
PMID: 15720169 (View on PubMed)

Williams KJ, Ravikumar R, Gaweesh AS, Moore HM, Lifsitz AD, Lane TR, Shalhoub J, Babber A, Davies AH. A Review of the Evidence to Support Neuromuscular Electrical Stimulation in the Prevention and Management of Venous Disease. Adv Exp Med Biol. 2017;906:377-386. doi: 10.1007/5584_2016_128.

Reference Type BACKGROUND
PMID: 27620314 (View on PubMed)

Westrich GH, Specht LM, Sharrock NE, Sculco TP, Salvati EA, Pellicci PM, Trombley JF, Peterson M. Pneumatic compression hemodynamics in total hip arthroplasty. Clin Orthop Relat Res. 2000 Mar;(372):180-91. doi: 10.1097/00003086-200003000-00020.

Reference Type BACKGROUND
PMID: 10738427 (View on PubMed)

Berliner JL, Ortiz PA, Lee YY, Miller TT, Westrich GH. Venous Hemodynamics After Total Hip Arthroplasty: A Comparison Between Portable vs Stationary Pneumatic Compression Devices and the Effect of Body Position. J Arthroplasty. 2018 Jan;33(1):162-166. doi: 10.1016/j.arth.2017.08.005. Epub 2017 Aug 24.

Reference Type BACKGROUND
PMID: 28927565 (View on PubMed)

Pitto RP, Hamer H, Kuhle JW, Radespiel-Troger M, Pietsch M. [Hemodynamics of the lower extremity with pneumatic foot compression. Effect on leg position]. Biomed Tech (Berl). 2001 May;46(5):124-8. doi: 10.1515/bmte.2001.46.5.124. German.

Reference Type BACKGROUND
PMID: 11413908 (View on PubMed)

Pitto RP, Young S. Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance. A comparative, prospective clinical trial. Int Orthop. 2008 Jun;32(3):331-6. doi: 10.1007/s00264-007-0326-9. Epub 2007 Feb 15.

Reference Type BACKGROUND
PMID: 17653546 (View on PubMed)

Fujisawa M, Naito M, Asayama I, Kambe T, Koga K. Effect of calf-thigh intermittent pneumatic compression device after total hip arthroplasty: comparative analysis with plantar compression on the effectiveness of reducing thrombogenesis and leg swelling. J Orthop Sci. 2003;8(6):807-11. doi: 10.1007/s00776-003-0706-y.

Reference Type BACKGROUND
PMID: 14648269 (View on PubMed)

Zhao JM, He ML, Xiao ZM, Li TS, Wu H, Jiang H. Different types of intermittent pneumatic compression devices for preventing venous thromboembolism in patients after total hip replacement. Cochrane Database Syst Rev. 2014 Dec 22;2014(12):CD009543. doi: 10.1002/14651858.CD009543.pub3.

Reference Type BACKGROUND
PMID: 25528992 (View on PubMed)

Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby G, Reddy DJ, Ntouvas I. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016 Sep 7;9(9):CD005258. doi: 10.1002/14651858.CD005258.pub3.

Reference Type BACKGROUND
PMID: 27600864 (View on PubMed)

Related Links

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Other Identifiers

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0014626/22

Identifier Type: -

Identifier Source: org_study_id

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