Bandaging technique after knee replacement

Abstract

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.Method 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.Interpretation 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.

A compression bandage improves local infiltration analgesia in total knee arthroplasty

“…One study concluded that a compression bandage reduces swelling and postoperative pain when compared to a non-compression bandage (Charalambides et al 2005). Our study was therefore carried out to investigate one of the central components in the LIA technique-the compression bandage.…”

Can A Modified Robert Jones Bandage After Knee Arthroplasty Reduce Blood Loss? A Prospective Randomized Controlled Trial

“…The compression was between 40 to 50 mm Hg pressure at application; pressure decreased to 2 to 10 mm Hg within 48 hours. The reported advantages of the Robert Jones bandage are reduced pain and swelling after surgery [2,6,21]. In an animal model, application of a compression bandage reduced postfracture swelling in the tissue [13].…”

“…Various surgical techniques [9,11,16,17,19], medications [5,15,22], and postoperative protocols [2,4,8,12] to reduce bleeding have been proposed. Various postoperative approaches including cold compresses [6], elastic bandage support [7], and compressive dressings [1] also have been reported for reduction of bleeding, soft tissue edema, and hemarthroses.…”

Device or Ice: The Effect of Consistent Cooling Using a Device Compared with Intermittent Cooling Using an Ice Bag after Total Knee Arthroplasty

“…Limiting blood loss reduces associated comorbidities, improves recovery and participation in rehabilitation, 13 and minimizes the need for blood transfusions. 14 Although compression used for at least 48 hours can provide effective control of intra-articular bleeding, 15 cryotherapy has only a small effect on intra-articular bleeding. 16 Although applying a bag of ice is a common method of postoperative cryotherapy, 17 the frequency, intensity, and duration of application vary, which may contribute to suboptimal care for patients.…”