Manual calf massage and passive ankle motion reduce the incidence of deep vein thromboembolism after total hip arthroplasty

Usefulness of Elastic Bandage Compression Compared to Calf Massage to Prevent Venous Thromboembolism-A Retrospective Evaluation

Background: Manual calf massage and passive ankle motion (CaM) can reduce the incidence of venous thromboembolism (VTE) after total hip arthroplasty (THA). However, these methods cannot be used in all patients; thus, elastic bandage (EB) compression is an alternative method. The efficacy of EB compression in preventing VTE has not yet been investigated; thus, this study aimed to compare the effects of EB compression and manual calf massage. Methods: Of the 363 patients who underwent unilateral primary THA at our hospital between 1 August 2018 and 31 October 2023, CaM without anticoagulation therapy was administered to 206 patients (CaM group) and 157 patients underwent EB without anticoagulation therapy (EB group). Duplex ultrasonography was performed 7 days postoperatively to check for deep vein thrombosis (DVT) in both legs. Results: The surgical time (122.2 min vs. 155.5 min), the incidence of DVT (4.5% vs. 4.8%) and pulmonary thromboembolism (PTE) (0% vs. 0.7%), intraoperative bleeding (305.4 mL vs. 301 mL), and estimated actual blood loss (846.6 mL vs. 811.6 mL) were not significantly different between the CaM and EB group. However, there was one case of symptomatic PTE in the EB group. Conclusions: The incidences of DVT, PTE, and intraoperative bleeding were not significantly different between the groups. Moreover, EB can be administered to patients with DVT and is considered to be a DVT prophylaxis method that can be used in a larger number of patients. Therefore, we recommend that EB be performed in all the patients undergoing THA.

Clinical Effect of Abdominal Massage Therapy on Blood Glucose and Intestinal Microbiota in Patients with Type 2 Diabetes

The aim of the study was to investigate the clinical effects of abdominal massage on patients with type 2 diabetes mellitus (T2DM) and its influence on the intestinal microflora. We conducted a randomized, controlled clinical trial. A total of 60 patients with T2DM, who met the inclusion criteria, were randomly allocated to the control group, the routine massage group, and the abdominal massage group. The control group received health education and maintained their hypoglycemic drug treatment plan. The routine massage group and the abdominal massage group received different massage interventions. In addition to glucose and lipid metabolism indicators, we quantitatively analyzed the gut microbiota to assess the effects of massage on the intestinal microflora of patients with T2DM. Compared with the control group, the abdominal massage improved levels of glycated hemoglobin, total cholesterol, Enterobacter, and Bifidobacteria with significant differences (P = 0.02, P = 0.03, P = 0.03, and P = 0.03). The comparison within group showed that the levels of the four bacterial genera in the abdominal massage group revealed significant differences before and after treatment (P = 0.006, P < 0.001, P < 0.001, and P = 0.002). The comparison between the routine massage group and the abdominal massage group was not significantly different in all levels of test indices. The abdominal massage group regulated levels of Enterobacter and Lactobacilli to a greater extent than the routine massage group. Additionally, abdominal massage decreased Enterococcus levels. The results of this study showed that abdominal massage has clinical advantages over routine massage. Specifically, this intervention may correct microflora disturbances to a certain extent.

Passive ankle motion and calf massage without anticoagulation therapy after total hip arthroplasty: A retrospective study

BACKGROUND

It has been previously reported that manual calf massage and passive ankle motion after total hip arthroplasty could reduce the incidence of venous thromboembolism. However, a combination of chemical and mechanical prophylaxes was employed. In this study, we aimed to examine the effect of mechanical prevention without pharmacological antithrombotic intervention.

METHODS

Of the 313 patients who underwent unilateral primary total hip arthroplasty and received passive ankle motion and calf massage postoperatively at our hospital between January 2015 and December 2019, 261 (58 men, 203 women; mean age 62.1 years) were included in this retrospective study. Pharmacological anticoagulation therapy was administered in 176 patients (combination group); 137 patients only underwent calf massage and passive ankle motion without anticoagulation therapy (single group). The study outcomes were operation time, the incidence of deep vein thrombosis, pulmonary thromboembolism, intraoperative bleeding, estimated actual blood loss, blood transfusion, and major bleeding.

RESULTS

No significant differences were found in sex, age, side, platelet counts, activated partial thromboplastin time, prothrombin time, prothrombin time - International Normalized Ratio, intraoperative blood loss, estimated blood loss, and operation time. Moreover, the incidence of deep vein thrombosis, pulmonary thromboembolism, and intraoperative bleeding was not significantly different between the groups (deep vein thrombosis 4.0% vs. 6.3%, p = 0.244; pulmonary thromboembolism 0.7% vs. 0%, p = 0.548; and intraoperative bleeding 394 ± 173.6 ml vs. 365.4 ± 168.5 ml, p = 0.550). However, estimated actual blood loss and postoperative bleeding differed between the groups (eABL 996.6 ± 348.3 ml vs. 858.5 ± 269.6 ml, p = 0.003; postoperative bleeding 601.8 ± 330.0 ml vs. 492.1 ± 277.1 ml, p = 0.016), and both increased in the combination group. No major bleeding was noted in the two groups.

CONCLUSION

Postoperative anticoagulant therapy does not have to be routinely used if mechanical prophylaxis is performed in patients without deep vein thrombosis before total hip arthroplasty.

Alternative physical treatments for deep venous thrombosis prophylaxis in surgical patients: a systematic review

INTRODUCTION

Venous thromboembolism (VTE) represents a major cause of morbidity and mortality. A variety of novel physical therapies have been proposed for patients in whom standard prophylaxis, including early mobilisation, is contraindicated. This article presents a systematic literature review of alternative physical treatments for VTE prophylaxis, focusing on surgical and trauma patients.

METHODS

Following protocol registration in PROSPERO, a systematic review was conducted in accordance with PRISMA. MEDLINE and EMBASE databases were searched for all studies indexed before 27th of July 2019. Two authors independently screened these articles. Data gathering for eligible articles was also undertaken in parallel by two authors. A formal risk of bias assessment was conducted for each study along with an assessment on the quality of the evidence using the GRADE framework.

RESULTS

A total of 272 abstracts were identified. After exclusion of duplicates and non-eligible articles, 10 publications were reviewed in detail. Two studies involving electrostimulation, another using a portable intermittent compression device and one study using postoperative calf massage reported a statistically significant reduction in the incidence of deep venous thrombosis when used in conjunction with LMWH. The remaining six articles did not show any significant benefits.

DISCUSSION

All studies reporting significant benefits have methodological flaws, with a high risk of bias. The evidence base informing alternative physical treatments as prophylactic measures in VTE is limited. Our data suggest that the use of these physical modalities can be beneficial in patients who also received LMWH, whilst these alone are of no benefit.

LEVEL OF EVIDENCE

II - Systematic Review Systematic Review Registration Number PROSPERO CRD42019133684.

Effect of self-calf massage on the prevention of deep vein thrombosis after total knee arthroplasty: A randomized clinical trial

OBJECTIVE

Deep vein thrombosis (DVT) is a severe complication after total knee arthroplasty (TKA). Performing self-calf massage may decrease the incidence of DVT. The purpose of this study was to investigate whether self-calf massage is effective for preventing DVT after TKA.

METHOD

In all, 165 patients participated in the present study. Patients were randomized to one of two groups: the self-calf massage group or the control group. In the control group, patients started regular physical therapy. In the self-calf massage group, in addition to regular physical therapy, patients were instructed to massage their calf muscles 30 times from the distal to proximal side. This procedure was repeated three times and was completed in 2 mins during the 2 days following TKA. All patients were evaluated for DVT on postoperative day 3 using lower limb vein ultrasonography.

RESULTS

The incidence of DVT was significantly lower in the self-calf massage group than in the control group. Self-calf massage was associated with a lower incidence of DVT, whereas age and female sex were risk factors for DVT.

CONCLUSION

This study showed that the self-calf massage may be beneficial for the prevention of DVT after TKA.

A Comparison of the Incidences of Venous Thromboembolism after Total Hip Arthroplasty between the Direct Anterior Approach and the Direct Lateral Approach, Especially in the Early Period after Introduction of the Direct Anterior Approach

OBJECTIVE

To compare the incidence of venous thromboembolism (VTE) after total hip arthroplasty (THA) using the direct anterior approach (DAA) with that using the direct lateral approach (DLA). In addition, patient background characteristics and the incidence of VTE were compared between the first half and the latter half of the period after introducing DAA and against DLA.

METHOD

This was a retrospective, multicenter study involving 109 patients (116 hips) who had undergone primary unilateral THA. Thirty-six hips underwent THA using DAA and 80 hips underwent THA using DLA. Patient information including sex, age, and preoperative diagnosis was collected. The incidence of VTE was compared between DAA and DLA. Moreover, the patients who underwent THA using DAA were divided into 2 groups (first half and latter half groups), and sex, age, body mass index (BMI), and surgical time were compared between the 2 groups. Moreover, the incidence of VTE was compared among the 3 groups (first half of DAA, latter half of DAA, and DLA).

RESULTS

The incidence of VTE in the DAA group was significantly higher than that in the DLA group (p=0.014). The incidence of VTE in the first half group was significantly higher than in the latter half group and the DLA group (p=0.035 and p=0.001, respectively), and there was no difference in the incidence of VTE between the latter half group and the DLA group (p=0.923). Surgical time was significantly longer in the first half group than in the latter half group (p=0.046).

CONCLUSIONS

In the first half of the period after introducing the DAA, more VTEs occurred than in the DLA. It may be important to shorten the surgical time in the early stage of introducing the DAA, and aggressive anticoagulation therapy may be required until the surgeon becomes familiar with the procedure.

Manual Massage Therapy for Patients with COPD: A Scoping Review

Background and objectives: Manual massage therapy is a therapeutic option for the treatment of several pathological conditions affecting the musculoskeletal system. It has been pointed out that massage might be beneficial for chronic obstructive pulmonary disease (COPD) patients thanks to therapeutic effects primarily related to hyperemia (increased skin temperature and blood flow), and activation of the lymphatic system. The present study reports current evidence on the systemic effects of manual massage in patients with COPD. Materials and Methods: A scoping review was conducted on five major databases. The search went through all databases since their inception until December 2018. Results: Seventy-eight citations were retrieved; after the selection process was completed, seven articles were considered eligible. In patients receiving manual massage, improvements were observed in Forced Expiratory Volume in 1 s, dyspnea perception, and in the 6-min walking test. Conclusions: To date, the use of manual massage in patients with COPD is not supported by substantial evidence in the literature: indeed, it is proposed as a therapeutic option in association with other interventions such as physical exercise.

Comprehensive functional exercises with patient education for the prevention of venous thrombosis after major gynecologic surgery: A randomized controlled study

OBJECTIVE

To explore the functional exercises of deep breathing and lower limb motions for the prevention of venous thrombosis in patients undergoing major surgery for gynecologic malignancy.

METHODS

All eligible patients admitted to the gynecologic oncology unit were randomized into the study and control groups. A comprehensive set of functional exercises was provided to the study group under the instruction and supervision of medical staff. All patients received pre- and postoperative educational material, followed by questionnaires about the patient's perception and satisfaction of the material, and all indicated prophylactic medications were administered.

RESULTS

In total, 132 patients were randomized, and 62 and 53 patients in the study and control groups, respectively, were included in the final analysis. Venous thrombosis, identified by symptoms and/or postoperative ultrasound, was found in 9 (17.0%) and 2 (3.2%) patients in the control and study groups, respectively, which was significantly different (p = 0.012), and most of these instances (9/11, 81.8%) were intramuscular vein thrombosis. The incidence of venous thromboembolism (VTE) was not significantly different (1 [1.9%] versus 1 [1.6%]) between the two groups. In the regression model, functional exercise was the only factor associated with venous thrombosis (odds ratio 0.170, 95% confidence interval 0.035-0.815, p = 0.032) adjusted with diagnosis and surgical parameters. The detailed educational material had improved the perception and satisfaction of patients about the prevention of VTE.

CONCLUSION

In a phase 3, single-center randomized controlled study, a comprehensive set of functional exercises combining deep breathing and lower limb motions would significantly decrease the risk of venous thrombosis in patients undergoing major surgery for gynecologic malignancy, especially the risk of intravascular thrombosis.

Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study

Objectives:

To determine the clinical characteristics and risk factors of Deep Venous Thrombosis (DVT) in patients with gynecological malignant tumor, facilitating gynecologists better prevent the fatal complication.

Methods:

The patients with gynecological malignant tumor treated in department of gynecology of our hospital between May 2013 and May 2018 were reviewed retrospectively. The clinical data of patients including gender, age, tumor staging, adenocarcinoma, surgery, operation time, hypertension, hyperlipemia, diabetes, coronary heart disease, radiotherapy, chemotherapy, hospital stay, and postoperative rehabilitation exercise were collected to analyze the clinical characteristics of patients and determine the risk factors of DVT.

Results:

In the current study, 67 patients were included in DVT group, and 554 patients were included in Non-DVT group. There were significant differences in age, hypertension, hyperlipemia, operation time, adenocarcinoma, tumor staging, radiotherapy and postoperative rehabilitation exercises between DVT and non-DVT groups (p<0.05). However, there was no significant differences in gender, coronary heart disease, diabetes, surgical treatment and hospital stay (p>0.05). In multivariate analysis, the factors including age, hypertension, adenocarcinoma, radiotherapy, and hyperlipemia were independent risk factors, while rehabilitation exercise was protective factor for DVT.

Conclusion:

In cases of gynecological malignant tumor, DVT screening should be given due importance, especially for those patients with old age, hypertension, hyperlipemia, adenocarcinoma, or history of radiotherapy. Rehabilitation exercise should be encouraged in these patients.