Skip to main content
SpringerLink
Log in

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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

A bulky compression dressing (Robert Jones bandage) is commonly used after TKA to reduce blood loss, pain, and swelling. However, it is unclear whether these dressings in fact reduce blood loss.

Questions/Purposes

We compared postoperative blood loss, pain, knee swelling, and postoperative complications in two types of postoperative dressings after TKA: a modified Robert Jones dressing (MRJB) and a conventional wound dressing.

Methods

We conducted a prospective, randomized, controlled trial of 60 patients who underwent a unilateral primary TKA at our institution between November 2010 and July 2011. After wound closure, the patients were allocated into two groups. Thirty patients had the MRJB applied for 24 hours (Group 1) and 30 patients had a conventional wound dressing applied (Group 2). Postoperative hemorrhages in the vacuum drain, units of transfused blood, postoperative pain, knee swelling, and complications were assessed at 24 and 48 hours postoperatively.

Results

We found no differences in the mean postoperative blood loss between the groups (Group 1, 418 mL versus Group 2, 467 mL). Blood transfusion amounts, postoperative pain, and knee swelling also were similar. Three patients in Group 1 experienced bruising and two patients in Group 2 also had bruising. One patient in Group 1 had a blister.

Conclusions

Although previous studies have shown reduced blood loss, pain, and knee swelling after application of a MRJB, we found no benefit of this bandage. Our data suggest a postoperative compression dressing is not necessary after primary TKAs.

Level of Evidence

Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Brodell JD, Axon DL, Evarts CM. The Robert Jones bandage. J Bone Joint Surg Br. 1986;68:776–779.

    PubMed  CAS  Google Scholar 

  2. Charalambides C, Beer M, Melhuish J, Williams RJ, Cobb AG. Bandaging technique after knee replacement. Acta Orthop. 2005;76:89–94.

    Article  PubMed  Google Scholar 

  3. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998;86:102–106.

    PubMed  CAS  Google Scholar 

  4. Denis M, Moffet H, Caron F, Ouellet D, Paquet J, Nolet L. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Phys Ther. 2006;86:174–185.

    PubMed  Google Scholar 

  5. Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C. Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop. 2006;30:253–256.

    Article  PubMed  CAS  Google Scholar 

  6. Gibbons CE, Solan MC, Ricketts DM, Patterson M. Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop. 2001;25:250–252.

    Article  PubMed  CAS  Google Scholar 

  7. Hughes DL, Crosby AC. Treatment of knee sprains: modified Robert Jones or elastic support bandage? J Accid Emerg Med. 1995;12:115–118.

    Article  PubMed  CAS  Google Scholar 

  8. Johnson DP. Wound hypoxia: the effect of continuous passive motion. Acta Orthop. 1993;64(suppl 252):34–40.

    Google Scholar 

  9. Kumar N, Saleh J, Gardiner E, Devadoss VG, Howell FR. Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss. J Arthroplasty. 2000;15:947–949.

    Article  PubMed  CAS  Google Scholar 

  10. Idusuyi OB, Morrey BF. Peroneal nerve palsy after total knee arthroplasty: assessment of predisposing and prognostic factors. J Bone Joint Surg Am. 1996;78:177–184.

    PubMed  CAS  Google Scholar 

  11. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML. Blood loss after total knee replacement: effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991;73:1037–1040.

    PubMed  CAS  Google Scholar 

  12. Ma T, Khan RJ, Carey Smith R, Nivbrant B, Wood DJ. Effect of flexion/extension splintage post total knee arthroplasty on blood loss and range of motion: a randomised controlled trial. Knee. 2008;15:15–19.

    Article  PubMed  CAS  Google Scholar 

  13. Matsen FA 3rd, Krugmire RB Jr. The effect of externally applied pressure on post-fracture swelling. J Bone Joint Surg Am. 1974;56:1586–1591.

    PubMed  Google Scholar 

  14. Ogata K, Whiteside LA. Effects of external compression on blood flow to muscle and skin. Clin Orthop Relat Res. 1982;168:105–107.

    PubMed  Google Scholar 

  15. Ortega-Andreu M, Pérez-Chrzanowska H, Figueredo R, Gómez-Barrena E. Blood loss control with two doses of tranexamic acid in a multimodal protocol for total knee arthroplasty. Open Orthop J. 2011;5:44–48.

    Article  PubMed  Google Scholar 

  16. Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev. 2007;3:CD001825.

    PubMed  Google Scholar 

  17. Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2004;86:1146–1152.

    Article  PubMed  Google Scholar 

  18. Pellegrini VD. DVT prophylaxis: better living through chemistry: affirms. Orthopedics. 2010;7;33:642.

    Google Scholar 

  19. Rama KR, Apsingi S, Poovali S, Jetti A. Timing of tourniquet release in knee arthroplasty: meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2007;89:699–705.

    Article  PubMed  Google Scholar 

  20. Sehat KR, Evans R, Newman JR. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee. 2000;7:151–155.

    Article  PubMed  Google Scholar 

  21. Yu GV, Schubert EK, Khoury WE. The Jones compression bandage: review and clinical application. J Am Podiatr Med Assoc. 2002;92:221–231.

    PubMed  Google Scholar 

  22. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F. A multimodal analgesia protocol for total knee arthroplasty: a randomized, controlled study. J Bone Joint Surg Am. 2006;88:282–289.

    Article  PubMed  Google Scholar 

  23. Webb JM, Williams D, Ivory JP, Day S, Williamson DM. The use of cold compression dressings after total knee replacement: a randomized controlled trial. Orthopedics. 1998;21:59–61.

    PubMed  CAS  Google Scholar 

  24. Zenios M, Wykes P, Johnson DS, Clayson AD, Kay P. The use of knee splints after total knee replacements. Knee. 2002;225–228.

Download references

Acknowledgments

We thank Chumpot Amatyakul MS for help with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand

    Piya Pinsornsak MD & Sukanis Chumchuen MD

Authors
  1. Piya Pinsornsak MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sukanis Chumchuen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piya Pinsornsak MD.

Additional information

Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Pinsornsak, P., Chumchuen, S. Can A Modified Robert Jones Bandage After Knee Arthroplasty Reduce Blood Loss? A Prospective Randomized Controlled Trial. Clin Orthop Relat Res 471, 1677–1681 (2013). https://doi.org/10.1007/s11999-013-2786-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-2786-0

Keywords

Search

Navigation