An assessment of the efficacy of compression bandaging on blood loss and acute pain following total knee arthroplasty

Kent, Jonathan Matthew

Medicine
March 2020

Thesis or dissertation


Rights
© 2020 Jonathan Matthew Kent. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

This thesis has been undertaken to assess whether compression bandaging can deliver improvements in important short-term outcomes such as blood loss and pain following total knee arthroplasty within an enhanced recovery setting.

To achieve this, a thorough appraisal of the literature has been undertaken, with a robust systematic review and meta-analysis being performed. From these results and appraisal of the literature a relevant clinical trial has been performed.

To analyse any potential reductions in acute post-operative blood loss and pain, due to a hypothesised tamponade like effect, a randomised controlled trial (RCT) was performed using a complete compression bandage system (Coban 2, 3m) as the intervention. This was compared to the current ‘standard’ care of a single layer of wool and crepe bandage. Further assessment and analysis of both tourniquet use and any potential correlation between blood loss and pain is also presented. As an embedded sub-study within a larger trial (KReBS), which will assess long term outcomes of compression bandaging, the results from this study could provide an explanation for any findings observed later in the main study.
The results from the trial, following multiple linear regression analysis, were surprising, with a statistically significant increase in blood loss (107mls) observed with compression bandage use. There were no statistically significant differences in pain scores or breakthrough analgesia use, although early removal, due to reports of pain were observed.

This is currently the largest RCT performed and is the only one to include the effects of tourniquet use. Set within an enhanced recovery setting it provides evidence that compression bandaging should not be used following TKA.

This thesis presents a new hypothesis to explain the unexpected blood loss results, suggesting excessive pressure from the compression bandaging resulting in increased haemolysis. The role of free fatty acids released during surgery and increased oxidative stress is also explored to explain the increase in hidden blood loss observed with compression bandaging.

Publisher
Hull York Medical School, The University of Hull and the University of York
Supervisor
Torgerson, David J. (David John), 1960-
Qualification level
Doctoral
Qualification name
MD
Language
English
Extent
2 MB
Identifier
hull:17945
QR Code