Bandaging technique after knee replacement.
BACKGROUND
Firm bandaging of the knee following knee replacement may prevent bleeding into the joint by a tamponade effect. We studied the pressure required to achieve tamponade, and then clinically compared the use of a compression bandage with the use of a standard crêpe bandage, with or without a drain.


METHODS
Transducers were used to measure the pressure achieved on the surface of the knee under different bandages, and within the knee following release of the tourniquet. We prospectively compared 3 series of 50 patients each: (1) with compression bandaging from toes to mid-thigh, (2) with crêpe bandage from mid-calf to mid-thigh alone, or (3) with crêpe bandage and suction drain.


RESULTS
The pressure within the joint at which tamponade occurs is 52-62 mm Hg. The pressure on the skin under a properly applied compression bandage is between 28 and 32 mm Hg, and this controls bleeding within the joint. Patients treated with compression bandaging recovered more quickly from the operation, had a shorter hospital stay, and a greater range of flexion on discharge. They had no swelling of the limb, rarely suffered a tense hemarthrosis, and had fewer complications.


CONCLUSIONS
The use of a compression bandage incorporating the foot and calf following knee replacement surgery, without the use of drains, confers specific advantages over the use of a crêpe bandage alone.
Charalambides
Charalambos
C
Orthopaedic Department, Epsom General Hospital, Surrey, UK. charalambos.charalambides@whittington.nhs.uk
Beer
Marilyn
M
Melhuish
John
J
Williams
Robert J
RJ
Cobb
Andrew G
AG
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001458:Bandages; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000517:prevention & control; D011312:Pressure; D011446:Prospective Studies; D016059:Range of Motion, Articular; D014111:Tourniquets