Compression therapy in the prevention of thromboembolic disease following total knee arthroplasty with a fast recovery protocol: A systematic review

Abstract

Thromboembolic disease (TED), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a serious postoperative risk after total knee arthroplasty (TKA). Enhanced recovery after surgery (ERAS) protocols emphasize early mobilization, warranting reassessment of mechanical prophylaxis, such as compression therapy. This systematic review evaluates the benefits of compression therapy in preventing TED in TKA patients under ERAS protocols combined with pharmacological prophylaxis. A systematic review was conducted, analyzing seven studies comparing combined mechanical and pharmacological prophylaxis with pharmacological prophylaxis alone. Primary outcomes included DVT and PE incidence, compliance, adverse events, and efficacy. Seven studies were included in this systematic review, including 871 patients. Combined mechanical and pharmacological prophylaxis reduced DVT rates. Continuous enhanced circulation therapy (CECT) with enoxaparin lowered DVT from 19.5% to 6.6% (relative risk reduction (RRR) 66.2%, p=0.018), while intermittent pneumatic compression (IPC) with rivaroxaban reduced rates from 18.3% to 8.3% (RRR 54.5%, p<0.01). Pneumatic plantar compression (PPC) decreased DVT from 67% to 27% in unilateral and 52% to 28% in bilateral TKA (combined RRR 54.2%, p<0.001). Graduated compression stockings (GCS) with anticoagulation reduced DVT from 13.0% to 6.0% (RRR 53.8%, p=0.0872). IPC with nadroparin lowered DVT from 3.9% to 2.6% (RRR 33.3%, p=0.65). PE incidence remained minimal across studies. When combined with anticoagulants, mechanical prophylaxis may have an additional role in diminishing DVT incidence while alleviating postoperative swelling and pain. However, optimizing compliance, standardizing protocols, and tailoring thromboprophylaxis to patient-specific risks remain key challenges. Future research should refine mechanical and pharmacological strategies to enhance safety, efficacy, and recovery in TKA patients.