Orthopaedic surgeons and thromboprophylaxis.

Abstract

Objective-To assess attitudes to the use of thromboprophylaxis among orthopaedic surgeons in the United Kingdom.Design and subjects-Single page postal questionnaire to all 926 active orthopaedic surgeons who are members of the British Orthopaedic Association.

Graded compression stockings in elective orthopaedic surgery

“…Despite this, the overall rate of DVT was low, 16.7%, in comparison with historical rates 1,2 and rates seen previously in the same unit. 7 A study by Ibegbuna, Delis and Nicolaides 14 showed that lightweight compression was sufficient to produce a significant effect on venous haemodynamics.…”

“…Surveys suggest that between 68% and 73% of orthopaedic surgeons use them routinely for the prophylaxis of deep-venous thrombosis (DVT). 1,2 It is estimated that the NHS spends over two million pounds on such products each year. 3 They are presumed to work by increasing the velocity of venous flow thus preventing venous stagnation in patients who are not walking.…”

Graded Compression Stockings for Prevention of Deep-Vein Thrombosis After Hip and Knee Replacement

“…Unlike pharmacological agents, mechanical methods do not interfere with haemostasis and are unlikely to cause bleeding complications; consequently, they are popular with orthopaedic surgeons. A postal survey of orthopaedic surgeons in the UK showed that 68% used graded compression stockings as prophylaxis for DVT (Laverick, Croal and Mollan 1991). Their efficacy has been well documented in abdominal surgery (Holford 1976;Scurr et al 1977;Allan et al 1983;Turner, Cole and Brooks 1984;Wille-Jorgensen et al 1985;Jeffery and Nicolaides 1990), but there is little information on their use in orthopaedic surgery (Barnes et al 1978;Ishak and Morley 1981;Ohlund, Fransson and Starck 1983).…”

The effect of the publication of a major clinical trial in a high impact journal on clinical practise: the ORACLE Trial experience

“…In 1601, James Lancaster showed that lemon juice was effective but it was not until 1747 that James Lind confirmed the results and then the British Navy did not fully adopt this innovation until 1795 (not until 1865 in the case of Merchant Marines) 4 . Among more recent examples of delayed implementation of research results are the ascertainment and control for hypertension 5,6 , the inadequate use of prophylactic antibiotics in patients having orthopaedic surgery 7 , the inadequate treatment of asthma 8 and the inadequate treatment of children with gastroenteritis 9 . In the case of thrombolytic treatment for myocardial infarction, there was a 13-year delay between the demonstration of effectiveness from cumulative meta-analysis of randomised controlled trials and the advocacy of it by most authors of review articles or book chapters 10 .…”