Drain clamping in knee arthroplasty, a randomized controlled trial

BACKGROUND: The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss, blood transfusion and no increase in complications compared to a routine continuous suction drainage system. This was a randomized prospective study on patients undergoing total knee arthroplasty. METHODS: Group A patients' drains were left clamped for all but 5 min (or 100 mL drainage) every 2 h for the first 6 h, then at 12-h and 24-h periods, when the drains were removed. Group B patients had continuous suction drainage. The amount of external blood loss, transfusion requirements and complications were compared between the two groups. The study group comprised 66 patients. RESULTS: The mean external blood loss in the clamped drain group was 296.67 mL (standard deviation 160.28 mL) with a mean drain in situ time of 32 h, significantly less (P < 0.05) than the continuous drain group that had a mean external blood loss of 796 mL (standard deviation 250.34 mL) with a mean drain in situ time of 34 h. There was no difference in the requirements for transfusion between the two groups. CONCLUSION: We conclude that clamping drains intermittently in hybrid total knee arthroplasty results in significantly less external blood loss with no change in morbidity or mortality. This study was a level 1 therapeutic study (i.e. with level of evidence randomized control trial with a significant difference).     

Closed suction drains do not increase the blood transfusion rates in patients undergoing total knee arthroplasty

We aim to determine whether the presence of a drain increases the actual blood transfusion rates in patients undergoing primary total knee arthroplasty (TKA). A retrospective review was performed on two consecutive groups of patients who underwent primary TKA: group 1 including 100 patients who underwent TKA and had one deep closed suction drain; group 2 including 100 patients who underwent TKA and had no drain. Blood transfusions were given post-operatively on the basis of clinical need without a pre-determined haemoglobin trigger factor. Group 1 drained a mean of 692 ml (range 150-1500) of blood in 48 h. The mean fall in haemoglobin at 48 h post-operatively was 3.26 g/dl in group 1 and 3.33 g/dl in group 2. Nine patients in group 1 and seven patients in group 2 required a blood transfusion; this was not statistically significant (P=0.79). Transfusion of primary TKA patients on the basis of clinical need can result in post-operative transfusion rates of 8%. The presence of a drain does not increase the transfusion rates of patients undergoing primary TKA.     

The Use of Reinfusion Drains after Total Knee Arthroplasty in Patients Treated with Low Molecular Weight Heparin for Thromboembolic Prophylaxis

The effect of closed-suction drainage with red-cell reinfusion on patients receiving low molecular weight heparin (LMWH) prophylaxis after total knee arthroplasty (TKA) has not been previously studied. Therefore, our goals were to determine the effect of reinfusion drains and LMWH on allogeneic transfusions and wound complications after TKA by comparing patients treated with and without drains. Overall, transfusion rates were lower in the drain group (40% vs 15%, P=.04). Patients with reinfusion drains had a significantly higher rate of allogeneic transfusion (15.8%) than those predonating autologous blood and no drain (5.4%, P=.0003). The drain group had lower rates of wound complications (P=not significant). We were unable to demonstrate the efficacy of red-cell reinfusion as a substitute for autologous donation in TKA.     

Effects of knee flexion following knee arthroplasty on postoperative blood loss: a study on 50 patients

Abstract Increased public and medical concerns regarding transfusion-associated infections and the cost involved in blood transfusion necessitate the imperative to justify transfusions. Since knee arthroplasties are often performed under tourniquet control, most blood loss occurs in the postoperative period. This makes this surgery ideally suited for evaluating techniques that decrease postoperative blood loss. A prospective study was carried out on 50 primary knee replacements (25 knees flexed, 25 knees extended) to evaluate the effect of maintaining the knee in 90 degrees of flexion in the immediate (24 h) postoperative period on postoperative need for transfusion. The volume of blood collected in the drains was used to estimate postoperative blood loss. Drop in haemoglobin was estimated by calculating the difference in preoperative and postoperative concentrations. Patients in the group with flexion of the knee lost a mean of 313 ml blood (2.0 g/dl drop in Hb); this was significantly less than that in the control (extension) group which lost 590 ml (3.2 g/dl drop in Hb). This decreased blood loss in the flexion group was reflected in the transfusion rates: 1 patient in the flexion group requiring transfusion compared to 6 patients in the extension group. Knee flexion following knee replacement is a simple yet effective method for decreasing postoperative blood loss and therefore transfusion rates.     

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Purpose

Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion.

Methods

We retrospectively compared the rate of postoperative blood transfusion in 418 cases of primary TKA during 2010 from a single institution with two different groups of patients, allocating cases to the group with MBLPA (group 1, study group, N = 71) and controls to the group without MBLPA (group 2, standard group, N = 347). MBLPA procedure included pre-operative haemoglobin (Hb) optimisation; femoral canal obturation; limited incision and release; peri- and intra-articular use of saline with adrenalin, morpheic chloride, tobramycin, betamethasone and ropivacaine; tourniquet release after skin closure; 24 hour drain under atmospheric pressure; and two doses of tranexamic acid (TXA) IV. In the control group, surgeons followed the standard procedure without blood-saving techniques. Case–control comparison and blood transfusion risk factors were analysed.

Results

Group 1 had a zero transfusion rate (0/71), whereas 27.4 % of patients (95/347) in group 2 received allogenic blood transfusion. Significant transfusion risk factors were pre-operative Hb <12 g/dl), American Society of Anesthesiologists (ASA) status III and nonobese body mass index (BMI); Age and gender were not significant risk factors.

Conclusions

MBLPA in primary TKA was highly effective, with a zero transfusion rate. Risk factors for transfusion were determined, and eliminating them contributed to the avoidance of allogeneic blood transfusion in our study series.     

Drain use in total knee arthroplasty is neither associated with a greater transfusion rate nor a longer hospital stay

Purpose

In recent years, the exclusion of a drain in total knee arthroplasty (TKA) is gaining popularity. This retrospective study aims to investigate a tertiary hospital’s experience with the use of a drain in TKA. The authors hypothesise that the use of a drain will: (1) increase the peri-operative total blood loss (TBL) and transfusion rate; (2) increase the length of hospital stay (LOS); (3) reduce the 30-day readmission rate and incidence of additional surgical procedure performed.

Methods

Patients who underwent a unilateral primary TKA in 2012 were included. Seven surgeons performed 575 TKAs with the use of drains, while nine other surgeons performed 902 TKAs without the use of drains. The patients were prospectively followed-up for two years. Peri-operative TBL was calculated using the haemoglobin balance method. All patients followed the hospital’s transfusion and post-operative rehabilitation protocol.

Results

There was a bigger drop in haemoglobin level by 0.5 g/dl (95 % CI, 0.4, 0.6) and greater TBL by 169 ml (95 % CI, 126, 181) in the drain group (both p?<?0.001). However, the transfusion rate was 37/575 (6.4 %) and 48/902 (5.3 %) in the drain and no drain groups respectively (p?=?0.370), while the LOS was four (IQR, 4, 5) and four (IQR 3, 5) days respectively (p?=?0.228). The 30-day readmission rate was 10/575 (1.7 %) in the drain group, compared with 26/902 (2.9 %) in the no-drain group (p?=?0.165). The incidence of additional surgical procedure performed was 5/575 (0.9 %) in the drain group, compared with 15/902 (1.7 %) in the no-drain group (p?=?0.198).

Conclusions

Although the use of a drain in TKA is associated with greater peri-operative TBL, this additional amount of blood loss does not translate into an increased transfusion rate or a longer LOS. It also does not reduce the 30-day readmission rate and incidence of additional surgical procedure performed on the same knee.

     

Closed suction drains,reinfusion drains or no drains in primary total knee replacement?

INTRODUCTION

Controversy still surrounds the use of drains after total knee replacement (TKR). We compared closed suction drains, reinfusion drains and no drains by studying haemoglobin (Hb) levels, blood transfusion requirements and functional knee outcome scores in a single surgeon series.

METHODS

A total of 102 consecutive primary TKRs were performed by the senior author between September 2006 and July 2008. All were cemented fixed bearing devices with patellar resurfacing. Of the 102 patients, 30 had closed suction drainage, 33 had an unwashed reinfusion drainage system and 39 had no drains. Data regarding pre and post-operative Hb and units transfused were gathered retrospectively. Pre and post-operative American Knee Society scores (AKSS) and Oxford knee scores (OKS) were recorded prospectively.

RESULTS

The pre-operative Hb levels were comparable among the groups. There was no statistically significant difference in Hb level reduction or autologous transfusion rates among the groups. Pre-operative AKSS and OKS were statistically comparable in each group. There was no statistical difference between the improvement in AKSS knee and function scores in all three groups. There was a slightly smaller improvement in the OKS of the ‘no drain’ group. There were no complications of drain usage and no deep infections. No patient required manipulation under anaesthesia and range of movement outcomes were the same for each group.

CONCLUSIONS

Our study does not support the use of either closed suction drains or reinfusion drains in primary elective TKR.     

El abordaje multidisciplinar es útil para la optimización de la hemoglobina preoperatoria en cirugía neoplásica colorrectal

Introduction

Optimising haemoglobin (Hb) levels less than 13 g/dl in the preoperative period can reduce the transfusion rate. With this aim, we developed a multidisciplinary protocol in our hospital for the treatment of patients proposed for colorectal cancer surgery.

Patients and method

A study was conducted on 437 patients who had surgery performed for colorectal cancer in the period 2005-2009. The data recorded were: demographic data, Hb and iron metabolism (Fe) at the time of diagnosis, Hb on the day of the surgery and on discharge, tumour location, preoperative adjuvant treatment (chemotherapy and/or radiotherapy), tumour stage (TNM), iron treatment, transfusion rate, and complications at 30 days. Patients were classified into Group A; Hb < 13 g/dl and/or abnormal Fe metabolism, and Group B; Hb > 13 g/dl and/or normal Fe metabolism.

Results

Of the total, 53.3% were in Group B and were treated with Fe; 73.6% intravenous (IV), and the rest oral. The mean dose of IV Fe was 867 mg. The mean intraindividual difference between the Hb on the day of surgery and at the initial value, increased by 0.6 g/dl in Group A, while it decreased by 0.8 g/dl in Group B. The mean intraindividual difference between the Hb at discharge and the diagnosis decreased by 0.4 g/dl in Group A compared to 2.5 g/dl in Group B. The overall transfusion rate was 8.6%. No statistically significant differences were observed in complications.

Conclusions

A multidisciplinary and early treatment of colorectal cancer enables patients with a low haemoglobin (Group A) to be optimised, as well as achieving a lower transfusion rate.     

A comparative analysis of the role of Tranexamic acid as an independent variable in reducing intraoperative blood loss in patients undergoing conventional total knee arthroplasty versus computer-assisted total knee arthroplasty

Background

Blood loss in total knee arthroplasty (TKA) is an area of significant concern as it has an effect on patient morbidity and hospital stay. Among many different modalities to reduce blood loss, the use of Tranexamic acid has become a standard procedure nowadays. The aim of our study was to determine if Tranexamic acid alone decreases blood loss as an independent variable irrespective of other blood loss preserving measures.

Method

This prospective non-randomized study included patients undergoing unilateral TKA by conventional method (Group 1) and computer-assisted TKA (Group 2). All the patients in both groups received Tranexamic acid in a dose of 10 mg/kg body weight prior to inflation of tourniquet. Blood loss in both the groups was calculated using Nadler’s formula, and haemoglobin (Hb) level was calculated on day one and day three after surgery.

Results

The mean drop of Hb in Group 1 was 1.608 and 1.56 g/dl in Group 2 which was statistically significant (p < 0.001); however, none of the patients in either of the groups actually required any blood transfusion postoperatively. Although there was a significant drop in haemoglobin and haematocrit in both the groups, on comparison, there was no significant difference in blood loss and fall in Hb levels between the groups (p > 0.001).

Conclusion

Tranexamic acid decreases blood loss in patients undergoing TKA independent of all the other blood conserving procedures.

     

Comparison between two methods of drain clamping after total knee arthroplasty

Introduction To study the clinical outcome of two methods of drain clamping after total knee arthroplasty and to determine the effect on blood loss and blood transfusion.Patients and methods A prospective study involving 73 patients, randomized into two groups. Group 1 included patients in whom the drain was clamped for 1 h postoperatively, after which it was released and kept open for 48 h. Group 2 included patients in whom the drain was clamped and released for 10 min every 2 h for 24 h. The drain was removed at 48 h in both groups. Patients demographic details, intraoperative and postoperative blood loss, and haemoglobin values on the preoperative and postoperative days (1, 4, 7, 14) were recorded.Results The mean postoperative drainage in group 1 was 520.65±170 ml, which was significantly higher than that of group 2, 367.62±141.1 ml (p<0.05, Students t-test). The drain charting shows 65% of drainage volume occurs in the first 8 h in both groups. The study suggests a reduction in the incidence of blood transfusion in the 2-hourly groups, although it was not statistically significant. There was a difference in the haemoglobin drop between both groups, but statistically the p value was marginally above 0.05 (p=0.086) and hence not significant.Conclusion The method of 2-hourly clamping of drain and release for 10 min significantly reduces postoperative blood loss, without any added increase of complication, after total knee arthroplasty.     

Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation

INTRODUCTION

A number of ways of reducing blood loss in arthroplasty have been explored, including preoperative autologous transfusion, intraoperative cell salvage and postoperative autologous transfusions. Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasty. In our department there was a change in practice from using postoperative retransfusion drains to intraoperative cell salvage. To our knowledge no study has directly compared using intraoperative blood salvage and postoperative retransfusion drains alone in total hip arthroplasty.

METHODS

This was a retrospective service evaluation including all primary hip arthroplasty performed under our care between January 2006 and December 2008. Patients were divided into two groups: Group A used a postoperative autologous blood transfusion (ABT) drain and Group B used intraoperative cell salvage.

RESULTS

A total of 144 patients were included in this study: 84 in Group A and 60 in Group B. The mean haemoglobin difference for Group A was 3.96g/dl (standard deviation [SD]: 1.52) and for Group B it was 3.46g/dl (SD: 1.42). The mean haematocrit difference for Group A was 0.12% (SD: 0.05) and for Group B it was 0.10% (SD: 0.04). Using an independent t-test for the comparison of means, a significant difference was found between Group A and B both in regards to haemoglobin difference (p=0.009) and haematocrit difference (p=0.046).

CONCLUSIONS

We feel that intraoperative cell salvage provides a more efficient method of reducing blood loss than postoperative retransfusion in primary total hip replacement. A prospective randomised study would be useful to ascertain any clinical difference between the two methods.     

Three-hour interval drain clamping reduces postoperative bleeding in total knee arthroplasty: a prospective randomized controlled trial

Background

Total knee arthroplasty (TKA) is a common procedure that has a risk of significant blood loss and blood transfusion, and carries a substantial risk for immunologic reactions and disease transmission. Drain clamping is a popular method that is applied to reduce blood loss after TKA. However, the clamping protocol remains controversial. Therefore, we established a new protocol, 3-h interval clamping, and compared the bleeding control efficacy of this protocol following TKA with the non-clamping technique.

Methods

Between March and July 2008, we enrolled 100 patients (100 knees) who underwent uncomplicated TKA using a minimally invasive surgical technique. The patients were randomly assigned into two groups based on the draining protocol: non-clamping (group A) and 3-h interval clamping (group B). For group A, a vacuum drain was connected to a container and was run continuously during the first postoperative day, whereas the vacuum was stopped twice (for ~3 h each time) for group B. Demographic characteristics and clinical data were collected, including the levels of hemoglobin and hematocrit, the total blood loss volume, the number of patients who required a blood transfusion, and any complications that developed. The perioperative data were compared between the two groups.

Results

The drainage blood volume in the interval-clamping group (group B) was significantly lower than that in the non-clamping group (group A) during the first 48 h following the procedure (p < 0.001 and p = 0.005 for first and second postoperative days, respectively). The mean fall in hemoglobin levels at 12 h in the interval-clamping group (2.8 ± 0.9 g/dL) was also lower than in the non-clamping group (3.2 ± 0.8 g/dL). In the 3-h interval clamping protocol, the number of patients requiring a transfusion was 2.2 times less than the number in the non-clamping protocol, but was not significantly different (odds ratio = 2.20, p = 0.24), and the significant predictor of blood transfusion was the preoperative hemoglobin level (odds ratio = 7.73, p < 0.001). No wound infection or clinical venous thromboembolisms were detected in our study.

Conclusion

The 3-h interval clamping is a newly developed protocol for reducing blood loss after TKA. The protocol lessens the decrease in postoperative hemoglobin levels. This protocol can be applied easily without increasing clinical thromboembolic events and wound complications.     

Blood transfusion and drainage catheter clamping are associated with ecchymosis formation at the surgical site after total knee arthroplasty: an analysis of 102 unilateral cases

Background

Many previous studies have focused on the postoperative complication of postoperative knee pain, infection, knee prosthesis loosening, periprosthetic fractures, and so on. There have been few studies focused on postoperative ecchymosis formation surrounding the wound of the TKA site. A certain degree of effect on the early functional recovery of the patients may occur due to the mental stress caused by the ecchymosis, which raises doubts regarding the success of the surgery. Therefore, it is particularly important to understand the risk factors for postsurgical ecchymosis formation after TKA, and specific measures for preventing ecchymosis should be taken. In this study, we reviewed the record of patients who received TKAs in our hospital, and a comprehensive analysis and assessment was conducted regarding 15 clinical factors causing postsurgical ecchymosis formation.

Methods

The records of 102 patients who received unilateral TKAs between January 2007 and May 2010 were retrospectively analyzed. Patients were divided into two groups based on the occurrence of ecchymosis.

Results

Of the 102 patients, 14 (13.7%) developed ecchymosis. Blood transfusion and drainage catheter clamping during the first few postoperative hours had a significant impact on the development of ecchymosis (p < 0.05). There was no difference in age, BMI, operation time, pre- and postoperative platelet count, and length of postoperative anticoagulant therapy between the two groups. Multivariate logistic regression revealed major risk factors for ecchymosis were postoperative blood transfusion (odds ratio (OR) = 15.624) and drainage catheter clamping (OR 14.237) (both, p < 0.05).

Conclusion

Blood transfusion and drainage catheter clamping after TKA due to excessive blood suction were associated with higher risks for ecchymosis formation surrounding the surgical site.     

Late Tourniquet Release and Drain Clamping Reduces Postoperative Blood Loss in Total Knee Arthroplasty

Background

Many studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty.

Questions/Purposes

The aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA.

Methods

Ninety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function.

Results

We found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function.

Conclusion

We conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery.     

Postoperative Intravenous Iron Supplementation Does Not Improve Hemoglobin Level and Transfusion Rate Following Staged Bilateral Total Knee Arthroplasty

BackgroundWe determined whether postoperative intravenous (IV) iron supplementation could reduce transfusion rate in patients undergoing staged bilateral total knee arthroplasty (TKA). Furthermore, we examined whether hemoglobin (Hb) levels and iron profile differed between patients with and without postoperative IV iron supplementation.MethodsThis retrospective, comparative cohort study included 126 patients who underwent primary staged bilateral TKA during a single hospitalization. The second TKA was performed at a week’s interval. Group iron (n = 65) received IV iron immediately after each surgery, while patients in group no-iron (n = 61) received no iron after surgery. Transfusion rate, change in Hb levels, and iron profile including serum iron, ferritin, total iron binding capacity, and transferrin saturation were evaluated preoperatively; on postoperative days 1, 2, and 4 after the first TKA; and postoperative days 1, 2, 4, and 7, 6 weeks, and 3 months after the second TKA.ResultsThere were no significant differences in Hb levels and transfusion rate following staged bilateral TKA between patients with and without postoperative IV iron supplementation although serum iron profiles were improved in patients with IV iron supplementation.ConclusionPostoperative IV iron supplementation immediately after acute blood loss caused by TKA was not effective in improving the transfusion rate. Therefore, surgeons should use protocols other than postoperative IV iron supplementation for reducing the transfusion rate in patients undergoing staged bilateral TKA in a single hospitalization.Level of EvidenceIII.     

Temporary Drainage Clamping After Total Knee Arthroplasty : A Meta-Analysis of Randomized Controlled Trials

Drainage-clamping methods are thought to be effective in reducing blood loss after total knee arthroplasty (TKA). We conducted a systematic review to examine if these methods were effective without increasing the risk of complications. After a comprehensive search, 6 randomized controlled trials involving 603 knees and comparing clamping drainage and the immediate release of the drain after elective TKA were included in this analysis. The results demonstrated that drainage clamping could decrease the volume of drainage, but only clamping for no less than 4 hours could reduce the true blood loss. There was no significant difference between the 2 groups regarding blood transfusion, postoperative range of motion, incidence of thromboembolic events, and wound complications. The current evidence cannot confirm the advantage of clamping drainage after TKA.     

The effects of drainage with a Redon versus a conventional drain on postoperative pain and blood loss after valve replacements

AIM: The aim of this study was to assess the influence of drainage with a Redon drain versus a conventional drain on postoperative pain and blood loss after valve replacements. METHODS: After approval by the local Ethics Committee and written informed consent, 30 patients, 20-60 years of age, scheduled for first elective valve replacement were included. After standardized anaesthetic regimens, cardiopulmonary bypass and coagulation therapy procedures and at the end of the operation, the patients were randomly assigned to 1 of 2 groups: (GI, n=15): drainage with 4 Redon drains; (GII, n=15): drainage with 2 conventional drains. Postoperative pain intensity at rest (VAS-R), during coughing and mobilization (VAS-M) in bed was independently evaluated using a visual analogue scale (VAS 100 mm) at 6 hourly intervals until 48 h after admission to the ICU (Ho). All patients received 2 g of paracetamol after obtaining the VAS score (8 g/24 h). No other analgesic agents were used. All patients were submitted to 2D echocardiography to verify the presence of pericardial effusion 24 h after surgery. Values are expressed as means. Pearson's chi squared and ANOVA (for repeated measurements) were used for statistical analysis. P<0.05 was considered significant. RESULTS: There was no statistically significant difference in the mean postoperative VAS-R and VAS-M, and in the mean postoperative total blood drainage 822.3 ml in GI, versus 704.3 ml in GII. Non pericardial effusion was found, and we did not see side-effects in any of the patients. CONCLUSIONS: We have shown that drainage with a Redon drains versus a conventional drain does not influence postoperative pain intensity and blood loss after valve replacements.     

Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial

Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding. In a prospective, randomised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis. We compared blood loss, number of transfusions, postoperative complications and knee function and found significantly less postoperative blood loss through the drains (p < 0.001), and fewer blood transfusions (p = 0.09) were needed in the clamped group. We conclude that clamping drainage after total knee arthroplasty in severe osteoarthritis reduces blood loss through the drains and the need for blood transfusions.     

Closed suction drainages in Lower Limb Joint Arthroplasty: A level I evidence based meta-analysis

IntroductionThe role of closed suction drainage during elective total joint arthroplasty is still unclear. The present study compared the use of closed suction drains to no drainage for elective total knee arthroplasty (TKA) and in total hip arthroplasty (THA) through a meta-analysis of randomized clinical trials (RCTs).MethodsFollowing the PRISMA guidelines, a meta-analysis of randomized controlled trials identified in December 2021. All randomized clinical trials comparing the use of closed suction drains to no drainage for elective THA or TKA were considered.ResultsTwenty-five RCTs were included in the final analysis. 49% (1722 of 3505) of patients received no-drainage, and 51% (1783 of 3505) received closed suction drainage. There was no evidence of a statistically significant evidence between the two groups in occurrence of postoperative infections (P = 0.4), mean total postoperative hemoglobin (P = 0.2) or length of hospital stay (P = 0.1). The no-drainage group showed a lower rate of blood transfusion (P < 0.0001).ConclusionThere is no evidence to support the routine use of closed suction drainage in THA or TKA patients.Level of evidenceLevel I, meta-analysis of randomized clinical trials.     

Developing an experimental model for surgical drainage investigations: an initial report

BackgroundWe sought to pilot and initiate validation of a surgical drainage model.MethodsWe designed a laboratory model to compare Jackson-Pratt surgical drains using 3 soups to emulate body fluids of serous, purulent, and necrotic debris. Each drain was trialed with each of the 3 fluids. Time and completeness of drainage were recorded. A survey of surgical residents and faculty was performed for convenience sampling.ResultsUnder serous conditions, the round Jackson-Pratt drained the cavity quicker, but left a larger residual volume of fluid. Under purulent conditions, the round Jackson-Pratt was slower and drained less fluid. With debris fluid, the round Jackson-Pratt was quicker with less residual fluid whereas the flat type clogged each time. Survey results showed adequate concordance with surgeons in agreement on soup choice.ConclusionsThe Jackson-Pratt drains perform differently depending on the drainage situation. The surgical community requires improved drain data to drive practice patterns.