The impact of exsanguination by Esmarch bandage on venous hemodynamic changes in total knee arthroplasty — A prospective randomized study of 38 knees

Elastic (Esmarch) bandage exsanguination is widely used in lower limb surgery to provide a bloodless operating field. Nevertheless, it is still not known exactly how exsanguination through Esmarch bandage usage contributes to venous pressure physiology following TKA. We wished to determine whether exsanguination with Esmarch bandage affects the venous hemodynamics of the lower limb in the first few weeks following TKA, so a prospectively randomized study was set.

We prospectively collected consecutive 38 male patients with unilateral advanced osteoarthritis of the knee. All of the subjects were randomly assigned to one of two TKA procedures: TKA with (Group A) or without (Group B) Esmarch bandage exsanguination. No pharmacologic thromboembolic prophylaxis was used in this study. The venous hemodynamics of each operated leg was assessed by strain-gage plethysmography, firstly before the operation, then postoperatively on days 2, 6, 14 and 28. The postoperative results revealed significant falls in venous outflow 2, 6 and 14 days following TKA in Group A; and 2 and 6 days following TKA in Group B. Twenty-eight days after TKA, venous outflow in both groups had returned to baseline level. Over the 28 days following the operation, Group A venous outflow tended to fall more significantly than in Group B. As with venous outflow, venous capacitance in both groups showed significant falls 2 and 6 days following TKA, with recovery to baseline levels 28 days postoperation. More significant falls in arterial filling index were recorded in Group A 6 days following TKA, returning to their baseline level 14 days postoperation. It appears that better leg venous hemodynamic changes are attained during the first month after TKA in Group B. We therefore question the need for exsanguination with Esmarch bandage before knee arthroplasty.