Intermittent pneumatic compression in total hip versus total knee arthroplasty: an exploratory comparative study on edema, functional outcomes and pain

L. Marin,^1-4 P. Patanè,¹ F. Manzoni,⁵ F. Cantaluppi,⁴ K. Spiteri,⁶ F. de Caro,^2,7 E. Caldarella,^2,7 A. Gatti,¹ L. Pedrotti^2,8 | ¹Laboratory for Rehabilitation and Orthopedic Surgery, Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; ²Laboratory of Adapted Motor Activity, Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Italy; ³Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Czech Republic; ⁴Department of Rehabilitation, “Città di Pavia” Healthcare Institute, Pavia, Italy; ⁵Epidemiology Unit, Agency for Health Protection of Pavia, Italy; ⁶St. Vincent de Paul Hospital, Luqa, Malta; ⁷Minimally Invasive Orthopedic Surgery Unit, “Città di Pavia” Healthcare Institute, Pavia, Italy; ⁸Department of Pediatric Diagnostic Surgical Clinical Science, Section of Pathologies of the Musculoskeletal System, Orthopedics Unit, University of Pavia, Italy

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are associated with postoperative edema and venous thromboembolism (VTE) risk. While intermittent pneumatic compression has shown benefits in orthopedic surgery, comparative evidence across these procedures remains limited. This exploratory study compared pneumatic compression effects on postoperative outcomes in THA vs. TKA patients. This prospective comparative study enrolled 24 patients (12 THA, 10 females; 12 TKA, 10 females) hospitalized between September 2022 and February 2023 at the Department of Orthopedic Surgery of the “Istituto di Cura Città di Pavia”, in Pavia (Italy). From the first (T0) to the tenth day after surgery (T1), all participants received standardized multimodal VTE prophylaxis (rivaroxaban, 10 mg/day; graduated compression stockings), neuromuscular electrostimulation (T-One Rehab, I-Tech Medical division, Scorzè, Italy), supervised physiotherapy, and intermittent pneumatic compression therapy (I-Press, I-Tech Medical division) twice daily for 30 minutes (pressure set at 100 mmHg). Comprehensive outcome assessments were performed at T0 and at T1, including limb circumferences (mid-thigh and calf), ankle range of motion (ROM), pain intensity via Numeric Rating Scale (NRS), and functional mobility using the 20-Meter Walk Test. Data were analyzed using RStudio (version 4.5.1). Both groups improved in thigh circumference reduction, perceived pain, and 20-m walk time. Calf circumference reduction was significant only in TKA. Ankle ROM gains were significant in TKA. The between-group comparison showed no significant differences in thigh circumference (3.83; 95% CI: −16.22 to 23.89), calf circumference (11.67; −13.16 to 36.49), pain (NRS: 1.08; −0.44 to 2.60), or 20-Meter Walk Test (−1.50; −10.80 to 7.79). There is a significant difference in favor of TKA for ankle ROM (−6.50; −12.11 to -0.90). Pneumatic compression showed comparable efficacy in edema control and functional recovery between THA and TKA, with TKA demonstrating superior ankle mobility gains. Larger studies are needed to confirm these findings and optimize procedure-specific protocols.