Multimodal DVT Protocol in Tourniquet-less Total Knee Arthroplasty

In recent years there has been significant progress towards more effective and practical
thromboprophylaxis in joint replacement surgeries. Since Aspirin 325mg twice daily has been
recently included as a nationally approved venous thromboembolism (VTE) prophylaxis in the
Surgical Care Improvement Project (SCIP) protocols for low risk total knee arthroplasty
(TKA) patients, it is necessary to optimize multimodal prophylaxis methods. These include
reduced tourniquet time, early mobilization, and mechanical compression devices (MCDs). MCDs
are commonly used as part of the in-hospital VTE prophylaxis measures; however, it has not
been demonstrated in clinical trials that optimal prophylaxis methods would be enhanced by
prolonged use of a MCD after discharge. In order to achieve this, a potentially valuable
solution has recently been made available to the outpatient population. The Cothera
VPulse(tm) is a MCD that combines rapid intermittent sequential compression with cold
therapy. It is designed for single patient use in the home and includes technology to track
patient compliance. The purpose of this study is to examine if there is a difference in DVT
occurrence over 3 weeks after tourniquet-less TKA and multimodal prophylaxis with or without
extended MCD use in a cooling device/MCD system.

Inclusion Criteria:

- TKA candidacy, osteoarthritis, patients able to understand study intent, and agree to
study participation

Exclusion Criteria:

- Subjects with personal or family history of DVT, currently taking
antiplatelet/anticoagulant drugs, genetic risk factor positive for VTE, pronounced
thrombocytopenia, GI bleed within 6 months of surgery, NSAID intolerance, orthopaedic
and medical co-morbidities that would prevent postoperative rapid mobilization and
compliance with MCD such as extra-articular pathology with referred pain to the knee
(spinal stenosis, neuropathy, ipsilateral hip disease), severe knee deformity,
post-traumatic and inflammatory arthritis, BMI above 40, active knee sepsis, remote
sites of active infection, ASA class > lll, cardiac disease failing medical
clearance, severe liver disease, peripheral artery disease, seizure disorder, alcohol
abuse, smoking abuse