Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial

Abstract

The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (p = 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (p = 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.

Keywords

total knee arthroplasty - knee osteoarthritis - closed suction drainage - vacuum wound drainage - prospective randomized trial

^* Marco Gesicki and Ulf Krister Hofmann contributed equally to the study.

• References

• 1 Cross M, Smith E, Hoy D. , et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73 (07) 1323-1330
• 2 Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26 (03) 355-369
• 3 Maradit Kremers H, Larson DR, Crowson CS. , et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
• 4 Turkiewicz A, Petersson IF, Björk J. , et al. Current and future impact of osteoarthritis on health care: a population-based study with projections to year 2032. Osteoarthritis Cartilage 2014; 22 (11) 1826-1832
• 5 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (07) 1487-1497
• 6 Harwin SF, Banerjee S, Issa K, Mont MA. Advances in total knee arthroplasty. J Knee Surg 2014; 27 (03) 169-170
• 7 Calvo R, Martínez-Zapata MJ, Urrútia G. , et al. Low- vs. high-pressure suction drainage after total knee arthroplasty: a double-blind randomized controlled trial. J Adv Nurs 2012; 68 (04) 758-766
• 8 Yildiz C, Koca K, Kocak N, Tunay S, Basbozkurt M. Late tourniquet release and drain clamping reduces postoperative blood loss in total knee arthroplasty. HSS J 2014; 10 (01) 2-5
• 9 Zhang QD, Guo WS, Zhang Q, Liu ZH, Cheng LM, Li ZR. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26 (08) 1265-1272
• 10 Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2004; 86-A [phone]
• 11 Padala PR, Rouholamin E, Mehta RL. The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration. J Knee Surg 2004; 17 (01) 24-27
• 12 Banerjee S, Kapadia BH, Issa K. , et al. Postoperative blood loss prevention in total knee arthroplasty. J Knee Surg 2013; 26 (06) 395-400
• 13 So-Osman C, Nelissen R, Brand R, Brand A, Stiggelbout AM. Postoperative anemia after joint replacement surgery is not related to quality of life during the first two weeks postoperatively. Transfusion 2011; 51 (01) 71-81
• 14 Kęska R, Paradowski TP, Witoński D. Outcome in primary cemented total knee arthroplasty with or without drain: a prospective comparative study. Indian J Orthop 2014; 48 (04) 404-409
• 15 Esler CN, Blakeway C, Fiddian NJ. The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 2003; 85 (02) 215-217
• 16 Jenny JY, Boeri C, Lafare S. No drainage does not increase complication risk after total knee prosthesis implantation: a prospective, comparative, randomized study. Knee Surg Sports Traumatol Arthrosc 2001; 9 (05) 299-301