BACKGROUND Although the medical advantages of autologous blood transfusion are undisputed today, it has been established only in a few hospitals. At our hospital we have employed infusion of previously stored autologous blood and normovolemic hemodilution routinely in all patients undergoing major orthopedic surgery since June 1, 1986. OBJECTIVE In this study the efficacy of additionally infusing salvaged drainage blood postoperatively in reducing the need for homologous blood transfusion was examined. METHODS From June 1, 1990 through December 30, 1993 the effectiveness of autotransfusion techniques with the additional use of postoperative infusion of salvaged blood was studied in 318 patients. RESULTS Preexisting anemia with hemoglobin value of less than 11 g/dl proved to be the only contra-indication for autologous blood transfusions and was found in 8 (2.5%) of our patients. These patients were not eligible for the autologous blood program. The 310 remaining patients were all given their previously stored autologous blood with hemodilution. In addition, 261 of these patients (84%) were also given salvaged drainage blood postoperatively using the solcotrans system or solcotrans-plus-orthopedic system. Of the total 310 patients, 218 (70.3%) did well without homologous blood. This was also true for 206 (78.9%) of the patients treated with all 3 autotransfusion procedures. No complications implicating the autotransfusion techniques were encountered. In addition, the method described and as employed in our hospital led to a cost reduction of about 40% compared to homologous transfusions. CONCLUSIONS The efficiency of autologous blood transfusions and hemodilution in reducing the need for homologous blood at our hospital, as previously described, could be increased by 22% using the solcotrans system. The advanced age of our patients (average 73 years) and the number of preexisting, in part considerable, medical problems permit the conclusion that these autotransfusion techniques are quite well tolerated. The contraindications could be reduced to a few exceptions. The logistics necessary to carry out these procedures are simple and can be achieved with a bit of will and effort in all hospitals including those of middle and small size.