Comparison of drain clamp after bilateral total knee arthroplasty

Suction drains provide an easy and feasible method for controlling hemorrhage after total knee arthroplasty. However, there has been no compromise regarding the optimum clamping time for these drains. We conducted a randomized clinical trial in 50 patients to compare 12-hour drain clamping and continuous drainage after total knee arthroplasty in terms of wound complications, blood loss, and articular arc of motion. To eliminate any other factor except duration of clamping, we chose to compare only knees belonging to a single patient and to restrict the study to those knees undergoing surgery due to osteoarthritis. From a total of 100 knees (50 patients) studied, the 12-hour-clamping method resulted in a significantly smaller amount of postoperative blood loss (p < 0.001). The passive ranges of motion and wound complications were not significantly different between the two groups.     

The use of postoperative suction drainage in total knee arthroplasty

A retrospective review of 299 total knee arthroplasties performed between 1973 and 1983 revealed 170 knees in which postoperative suction drainage was used and 129 knees in which drains were not used. Comparison between these two groups revealed no statistically significant difference in wound problems, postoperative temperatures, or resulting range of motion. However, blood transfusions were given more than twice as often to the patients whose knees were drained (39% compared to 16%, p less than .01). The drained group also had a greater decrease in hemoglobin than the nondrained group (3.1 gm compared to 2.6 gm, p less than .01). In a review of these patients, no advantage was found for the use of postoperative suction drainage in the uncomplicated total knee arthroplasty.     

Advantages of clamping and drainage over continuous drainage in a total knee arthroplasty

IntroductionThe use of closed-suction drainage systems after total knee arthroplasty (TKA) is common practice in India, but with no consensus on its use. In this retrospective study, we compared whether clamped or unclamped drainage has any advantages over the other in unilateral TKA.MethodsGroup-A (n = 351) had an unclamped drain removed at 24 h postoperative, with measurement of total drainage at 24 h between January 2011 and February 2013. Group B (n = 349) had drains kept for a total of 8 h-clamped for the first 4 h and unclamped for a further 4, between March 2013 to September 2016. Drainage volume, as well as the hemodynamic markers-hemoglobin (Hb) drop, transfusion rate were evaluated.ResultsMean drain output in Group- A was significantly higher than Group- B (215.64 ml versus 28.34 ml). The postoperative Hb was significantly higher in Group-B (11.46 g/dl versus 10.57 g/dl). Mean Hb drop was significantly higher in Group A (2.16 g/dl versus 1.18 g/dl). The transfusion rates were lower in Group-B, though not statistically significant.ConclusionsThe 4- hour clamping method effectively reduces drain output and fall in hemoglobin. For those who continue using closed suction drains, clamping could prove to be an effective way of reducing post-operative blood loss and the need for transfusions.     

Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study

In a prospective, randomized study, 58 patients with primary cemented hip arthroplasty and 39 patients with primary cemented knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage. There was no difference in healing of the wounds, postoperative blood transfusions, complications, or range of motion. Although there was more soaked dressing requiring reinforcements in the groups without drainage, as a result of this study, we no longer use drains in uncomplicated cemented primary hip and knee arthroplasties for osteoarthritis.     

Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty

A prospective randomized trial of postoperative drainage-clamping practice was performed in 89 knees undergoing total knee arthroplasty. In group 1 (43 knees), drainage was clamped for the first 4 postoperative hours. In group 2 (46 knees), drainage was not clamped. The average bloody drainage was significantly less in group 1 than group 2 (514.85 +/- 378.0 vs 843.4 +/- 366.4 mL). The decrease of hemoglobin and hematocrit after surgery was also significantly less in group 1. Group differences between postoperative range of motion and narcotics requirements, length of stay, immediate wound problems, and deep vein thrombosis were nonsignificant. These results suggested that clamping the drainage in the first 4 postoperative hours reduces postoperative blood loss without causing excess morbidity after total knee arthroplasty.     

A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty

We undertook a prospective, randomised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with post-operative blood salvage in reducing blood loss in 212 total knee arthroplasties. The mean post-operative drained blood volume after drain clamping was 352.1 ml compared to 662.3 ml after blood salvage (p < 0.0001). Allogenic blood transfusion was needed in one patient in the drain group and for three in the blood salvage group. Drain clamping with intra-articular injection of saline with adrenaline is more effective than post-operative autologous blood transfusion in reducing blood loss during total knee arthroplasty.     

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).     

Investigation of the use of drained blood reinfusion after total knee arthroplasty: a prospective randomised controlled study

PURPOSE: To compare the use of a blood salvage and reinfusion system with standard allogeneic blood transfusion after total knee arthroplasty--a procedure associated with significant postoperative blood loss. METHODS: Between June 2002 and May 2004, 60 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion group (n = 26) or a control group (n = 34). Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery. Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l, or in the presence of severe anaemic symptoms. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery. RESULTS: There was no significant difference between the 2 groups in demographic data, drain output, total blood loss, and mean postoperative haemoglobin levels. Significantly more allogeneic blood was required by the control group than by the reinfusion group (p = 0.022). CONCLUSION: Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty, while having an effect on postoperative haemoglobin level equivalent to standard allogeneic blood transfusion.     

Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty

BACKGROUND: Prolonged wound drainage following total hip or total knee arthroplasty has been associated with an increased risk of postoperative morbidity. The purpose of this study was to determine the pharmacologic, surgical, and patient-specific factors that are associated with prolonged wound drainage and the relationship of this complication to the length of hospital stay and the rate of wound infections. METHODS: We conducted a retrospective observational study of 1211 primary total hip arthroplasties and 1226 primary total knee arthroplasties. Prospectively collected data included body mass index, intraoperative blood loss, surgical time, type of prophylaxis against deep venous thrombosis, and length of hospital stay. The association of these factors with the duration of postoperative wound drainage was analyzed. An acute infection developed after fifteen primary total hip arthroplasties and ten primary total knee arthroplasties. The patients with an acute postoperative infection were compared with their uninfected counterparts, and an odds ratio was determined to estimate the risk of prolonged wound drainage resulting in a wound infection. RESULTS: Morbid obesity was strongly associated with prolonged wound drainage in the total hip arthroplasty group (p = 0.001) but not in the total knee arthroplasty group (p = 0.590). An increased volume of drain output was an independent risk factor for prolonged wound drainage in both groups. Patients who received low-molecular-weight heparin for prophylaxis against deep venous thrombosis had a longer time until the postoperative wound was dry than did those treated with aspirin and mechanical foot compression or those who received Coumadin (warfarin); this difference was significant on the fifth postoperative day (p = 0.003) but not by the eighth postoperative day. Prolonged wound drainage resulted in a significantly longer hospital stay in both groups (p < 0.001). Each day of prolonged wound drainage increased the risk of wound infection by 42% following a total hip arthroplasty and by 29% following a total knee arthroplasty. CONCLUSIONS: Morbid obesity, the use of low-molecular-weight heparin, and a higher drain output were associated with a prolonged time until the postoperative wound was dry following a primary total hip arthroplasty, whereas a higher drain output was the only risk factor associated with prolonged drainage following a primary total knee arthroplasty. Prolonged drainage was associated with a higher rate of infection following a primary total hip arthroplasty, whereas obesity was the only identified independent risk factor for postoperative infection following a primary total knee arthroplasty.     

全膝关节置换术后不同引流方式的临床对比研究

目的 探讨人工全膝关节置换术后不同引流方式对临床疗效的影响.方法 将2010年10月至2012年11月55例接受单侧初次人工全膝关节置换患者分为三组:引流自体血回输组25例、延迟开放引流组12例、常规引流组18例.各组采用相同的手术技术和术后处理,比较术后总引流量(包括术中开放止血带止血时的出血量),异体血输血情况,术后第1、3、7天体温,手术前后血红蛋白值,肢体肿胀情况,伤口愈合质量和术后关节功能.结果 引流自体血回输组平均引流量为(799.2±196.7) ml,明显多于其他两组;延迟开放引流组平均引流量为(381.7±129.2) ml,明显少于常规引流组(666.1±155.0) ml.常规引流组术后第1天血红蛋白平均为(81.33±9.86) g/L,引流自体血回输组平均为(91.96±9.57)g/L和延迟开放引流组平均为(91.50±7.92) g/L,较常规引流组明显升高,差异有统计学意义;而引流自体血回输组与常规引流组的差异无统计学意义.常规引流组有8例患者(44.4％)术后接受异体血输注,明显多于引流自体血回输组(4例,16.0％)和延迟开放引流组(2例,16.7％),差异有统计学意义;引流自体血回输组与常规引流组的差异无统计学意义.引流自体血回输组术后第1、3、7天最高体温明显增高,与其他两组的差异有统计学意义.术后肢体肿胀、伤口愈合质量和术后关节功能三组的差异无统计学意义.结论 延迟开放引流可以减少术后显性失血,降低异体血输注率,与自体引流血回输相比,降低术后发热和额外费用,带来更大的临床收益,值得进一步探讨和应用.     

Efficacy of closed wound drainage after total joint arthroplasty: A prospective randomized study

The efficacy of closed suction drains following joint arthroplasty operations was prospectively evaluated in a randomized manner. All 88 patients allotted to primary knee or hip arthroplasty operations during a 6-month period were included in the study. Drains were used in 32 of 58 patients following total knee arthroplasty and in 18 of 30 total hip arthroplasties. No statistical difference was found in the hemoglobin levels measured following surgery and in the number of patients requiring blood transfusions between the two groups after total hip arthroplasty (P = .06). The power of the test to detect a difference of 2 g% in hemoglobin levels is 94%. Two patients from each group had a transient serous discharge for 3 to 4 days following surgery and none had wound infections. Significantly more blood transfusions were needed in patients with drains following total knee arthroplasty compared with patients without drains (0.7 unit per patient versus 0.2 unit per patient, P = .005) to maintain the same hemoglobin blood levels. Patients with no drains had significantly more transient sterile serous wound discharge than patients with drains (38.4% vs 12.5%, P = .02). Superficial wound infection necessitating antimicrobial medication developed in one patient with drains and in no patients in the other group. These results suggests that drains may not be needed following total hip arthroplasty. The more common serous wound discharge may be of some concern when drains are not used following total knee arthroplasty.     

No Clear Advantage to Use of Wound Drains After Unilateral Total Knee Arthroplasty : A Prospective Randomized, Controlled Trial

We conducted a prospective randomized, controlled trial in 100 patients to compare the postoperative use of wound drains with the use of no drains in patients who underwent unilateral primary total knee arthroplasty to determine differences in blood loss, range of motion, wound healing, complications (deep vein thrombosis, wound infection), and need for blood transfusions. The patients, who underwent surgery between February 2006 and February 2007, were randomly divided into 2 groups of 50 each: group A, treated without a drain, and group B, treated with a drain. The between-group difference in total blood loss was significant: 535 ± 295 mL in group A and 853 ± 331 mL in group B. Group A needed comparatively less blood transfused than group B did. Differences in wound infection, incidence of deep vein thrombosis, and range of motion were not statistically significant between groups. We found no clear advantage to the use of wound drains in unilateral total knee arthroplasty.     

Comparison of autologous transfusion drains versus no drain in total knee arthroplasty

Primary total knee arthroplasty is associated with blood loss both during surgery and in the immediate postoperative period, that may require allogenic blood transfusion. In view of the risks and financial implications of using allogenic blood, an accepted solution has been to utilise autotransfusion drains in the postoperative period thus allowing re-infusion of a patient's own blood. A number of studies have compared retransfusion techniques with standard drain use, but few report comparison with no drain use at all. We analysed data from patients undergoing primary total knee arthroplasty within our unit over an 18-month period. A total of 121 patients were included in the study: 53 received retransfusion drains whilst the remaining 68 received no drain at all. The mean postoperative haemoglobin drop was not significantly different between the two groups (p > 0.05). In the retransfusion group only one patient (2%) required allogenic blood transfusion postoperatively, whilst 4 of the 68 (6%) did so in the control group. This difference was not statistically significant either. This study showed a low rate of allogenic blood use postoperatively (< 5%) where either a retransfusion drain or no drain was used at all. However because there was no measurable difference between the two, we conclude that using a retransfusion technique does not appear to be of significant financial or clinical benefit with regards to allogenic blood transfusions compared with using no drain.     

Postoperative drainage of knee arthroplasty is not necessary: A randomized study of 90 patients

We studied the management of postoperative drainage after total knee replacement (TKR). 90 primary total knee joint arthroplasties were prospectively randomized into 3 groups: a) no drain, b) an autotransfusion system, c) a standard disposable closed suction drainage system. We monitored hemoglobin and hematocrit values, drainage volume and transfusions (homologous and autologous), range of knee motion, knee swelling and hospital stay. Parameters were recorded preoperatively, days 0-8 and 4 months postoperatively. No significant differences were seen between the groups in any of the parameters measured. The results show no benefit from using postoperative drainage systems in knee arthroplasties. Savings of SEK 400 (USD 55) per patient would have resulted if drains had not been used at all.     

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.     

Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients

INTRODUCTION: We performed a prospective, randomized, double-blind study on 40 patients scheduled for primary total hip arthroplasty due to arthrosis or osteonecrosis to determine the effect of tranexamic acid on per- and postoperative blood losses and on the number of blood transfusions needed. PATIENTS AND METHODS: 40 patients were randomized to tranexamic acid (10 mg/kg given as a bolus intravenous injection, followed by a continuous infusion of 1 mg/kg/hour for 10 hours) or placebo (20 mL saline given intravenously) 15 minutes before the incision. We recorded the peroperative and postoperative blood losses at removal of the drain 24 hours after the operation and the number of blood transfusions. RESULTS: Patients receiving tranexamic acid had a mean peroperative blood loss of 480 mL versus 622 mL in patients receiving placebo (p = 0.3), a postoperative blood loss of 334 mL versus 609 mL (p = 0.001), a total blood loss of 814 mL versus 1231 mL (p = 0.001) and a total need for 4 blood transfusions versus 25 (p = 0.04). No patient in either group had symptoms of deep venous thrombosis, pulmonary embolism or prolonged wound drainage. INTERPRETATION: Transemic acid is effective in reducing the postoperative blood loss, the total blood loss and the need for blood transfusion in primary total hip arthroplasty.     

The use of postoperative suction drainage in total hip arthroplasty.

Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains were used and 163 hips in which drains were not used. These two groups were compared for possible differences in wound problems, temperature elevations, changes in Hgb/Hct, and the need for transfusions. There was no statistically significant difference in postoperative temperatures or decrease in Hgb. However, there were four superficial wound infections in the drained group and three superficial wound infections in the non-drained group (P < .025). There were no deep infections in either group. These findings suggest closed suction drainage provides no apparent advantage in uncomplicated primary total hip arthroplasty.     

Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplastyA prospective randomized double-blind study in 40 patients

Introduction: We performed a prospective, randomized, double-blind study on 40 patients scheduled for primary total hip arthroplasty due to arthrosis or osteonecrosis to determine the effect of tranexamic acid on per- and postoperative blood losses and on the number of blood transfusions needed. Patients and methods: 40 patients were randomized to tranexamic acid (10 mg/kg given as a bolus intravenous injection, followed by a continuous infusion of 1 mg/kg/hour for 10 hours) or placebo (20 mL saline given intravenously) 15 minutes before the incision. We recorded the peroperative and postoperative blood losses at removal of the drain 24 hours after the operation and the number of blood transfusions. Results: Patients receiving tranexamic acid had a mean peroperative blood loss of 480 mL versus 622 mL in patients receiving placebo (p= 0.3), a postoperative blood loss of 334 mL versus 609 mL (p= 0.001), a total blood loss of 814 mL versus 1231 mL (p= 0.001) and a total need for 4 blood transfusions versus 25 (p= 0.04). No patient in either group had symptoms of deep venous thrombosis, pulmonary embolism or prolonged wound drainage. Interpretation: Transemic acid is effective in reducing the postoperative blood loss, the total blood loss and the need for blood transfusion in primary total hip arthroplasty.     

Complications in total knee arthroplasty with and without surgical drainage

The standard practice in total joint arthroplasty has included the use of postsurgical drains to minimize perioperative wound complications, particularly infection. This practice is not without cost and potential morbidity. Our recent cemented and cementless total knee arthroplasties (TKAs) have been done without the use of postoperative surgical drains and without any appreciable increase in wound complications. To confirm this, we retrospectively reviewed 227 consecutive TKAs, specifically evaluating perioperative wound complications. No statistical increase in perioperative complications in TKAs without drains was found. A lower percentage of complications was seen in the cementless population when compared with cemented or drained knees. We suggest that surgical drainage is not required in TKA, even when cementless fixation is used.     

Relevance of wound drainage in total knee arthroplasty--a prospective comparative study

AIM: The benefits of postoperative wound drainage in patients with total knee arthroplasty (TKA) with regards to mobilisation and wound healing were studied. We wanted to determine the efficacy of an autologous blood retransfusion system. METHOD: 150 patients with TKA were divided into three groups of 50 patients: A) three wound drainages with an autotransfusion system and suction; B) no wound drainage; C) one intraarticular wound drainage without suction. Hemoglobin values, blood transfusion requirements, blood loss, postoperative range of motion, Insall knee score and rate of complications were observed and recorded. All patients were operated without tourniquets for lower blood loss. RESULTS: In the group of patients with wound drainage and a retransfusion system the requirement of postoperative additional blood transfusion was not significantly less than in the group without wound drainage. Group A had the highest blood loss of all. The group without wound drainage had more hematomas and wound healing complications. Best results were observed within the group with one intraarticular drainage without suction. The rate of complications was not increased and the blood transfusion requirements were the lowest. CONCLUSION: This study shows that total knee replacement involving one intraarticular wound drainage without suction attains the best results.