Knee Arthroplastry Results in Foot Drop Due to TED Stockings

This case involves a fifty-two-year-old female patient who, following a knee arthroplasty, resulted in foot drop. The plaintiff initially presented to her orthopedic surgeon with osteoarthritis and the decision was a total knee replacement. During the procedure, a prosthetic was implanted as well as a TED stocking, to enhance circulation, prevent blood clots, and the use of anti-clotting medications. She used the stocking on for three days and on the third day; she complains that her foot was immobile. The resident who observed her that day believed that her foot drop was due to peroneal nerve damage. The resident informed the doctor and he ordered the resident to take off the stocking immediately, which he did not. The next day, the doctor observed the patient and saw that the stocking was still on and took it off. The plaintiff now has permanent nerve damage, where she has to wear a brace that fixes her foot in a position to allow her to walk. The plaintiff believes the TED stocking injured her nerve causing the foot drop and that it was not handled correctly, as to the timeliness of removing the stocking as well as the actual fit.

Question(s) For Expert Witness

1. What is the purpose for TED stockings post-operatively?

Expert Witness Response

There is less convincing evidence regarding the efficacy of graduated compression stockings. (GCS) In one study, GCS for seven days was compared with LMW heparin given for either 7 or 14 days in patients undergoing knee arthroscopy with or without more extensive surgery. LMW heparin was superior to GCS in the prevention of asymptomatic proximal DVT, symptomatic VTE and all cause mortality compared with GCS. There was no difference in bleeding rates. In one study, the addition of GCS to LMW heparin or fondaparinox in patients undergoing total hip replacement or hip fracture surgery did not improve efficacy over use of the pharmacologic agent alone. However one meta-analysis concluded that, although the use of GCS alone was effective in the prevention of DVT in surgical patients, the combined use of GCS and a pharmacologic agent was superior in reducing the overall incidence of DVT. The reasoning for resorting to stockings is not known, however, it has shown that they are less effective than anticoagulation.