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. 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.