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.

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Background Surgibone Unilab is prepared from bovine bone and contains hydroxyapatite and protein. It is supposed to be immunogenically inert but the protein could be antigenic in man.Patients and methods We followed 27 patients for an average of 2.5 (1-5) years, all of whom had received Surgibone mixed with autograft to fill in defects in the acetabulum and the proximal femur in revision hip surgery.Results In 17 patients, there was apparently complete incorporation of the bone graft within 6 months. In 3 of these patients, the graft was incorporated after 3 months. In 3 patients, however, there was no incorporation of the graft as late as 3 years after the operation. 3 other patients appeared to have a type of graft rejection (pseudoinfection). 1 other patient suffered MRSA deep infection of the prosthesis which resulted in removal of the implants 1 month postoperatively.Interpretation Use of Surgibone xenograft in revision hip surgery, even in combination with autograft, resulted in failure and the need for rerevision in at least one quarter of the cases studied.

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