Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach

Abstract

Introduction Wondering if the use of drains allowing retransfusion of shed blood as opposed to closed suction drains or no drains would improve quality of care to patients undergoing simple non-cemented primary total hip replacement (THR) using a direct anterior approach, a three-arm prospective randomized study was conducted. Method One hundred and twenty patients were prospectively randomized to receive no drain, closed suction drains or drains designed for re-transfusion of shed blood. Blood loss, VAS pain scores, thigh swelling, hematoma formation, number of dressings changed and hospital stay were compared and patients followed for 3 months. Results Drains did not have any significance on postoperative haemoglobin and haematocrit levels or homologous blood transfusion rates. Patients receiving homologous blood transfusions had too small drain volumes to benefit from re-transfusion and patients, who get drained fluid re-transfused, were far away from being in need of homologous blood transfusion. Omitting drains resulted in more thigh swelling accompanied with a tendency of slightly more pain during the first postoperative day but without effect on clinical and radiological outcome at 3 months. Earlier dry operation sites resulting in simplified wound care and shorter hospital stay was encountered when no drain was used. Conclusion The possibility to re-transfuse drained blood was not an argument for using drains and, accepting more thigh swelling, we stop to use drains in simple noncemented primary THR using the direct anterior approach.

Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis

“…Following the search strategy outlined above, and the inclusion and exclusion criteria, the two independent reviewers located 20 RCTs [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] involving 3,186 patients for our analysis ( Table 2). The entire process is shown in Fig.…”

“…Data on limb swelling were reported in ten studies [3,5,7,12,14,17,[19][20][21][22]. Two studies [19,20] supported the conclusion that the use of drainage can reduce the incidence of limb swelling or decrease the volume of the swelling.…”

“…Data on limb swelling were reported in ten studies [3,5,7,12,14,17,[19][20][21][22]. Two studies [19,20] supported the conclusion that the use of drainage can reduce the incidence of limb swelling or decrease the volume of the swelling. However, based on the data pooled from three studies [5,6,22], no evidence to support the hypothesis that the rate of limb swelling was reduced by using drainage when compared with the placebo group was obtained (OR, 0.43 [95 % CI, 0.11-1.77]; p=0.24).…”

“…And no definitive conclusion regarding the effect on blood loss of closed-suction drainage in THA could be drawn. The number of patients who needed homologous transfusion was reported in seven studies [5,6,12,14,15,20,21], and the pooled data was significantly less in the no drainage group who needed transfusion compared with the control group (OR, 1.68 [95 % CI, 1.15-2.46]; p=0.007) (Fig. 4).…”

“…The amount of transfusion showed no significant differences between the two groups, depending on the data pooled from three studies [12,15,17] (WMD, 0.81 [95 % CI, -0.34-1.96 u ]; p=0.17). Postoperative haemoglobin was reported by nine of the individual studies [5-7, 11, 15, 16, 18, 20, 22], while five studies [8,14,18,20,22] reported a change in the haematocrit. However, none reported any significant difference, except Gonzalez Della Valle et al [14], who reported that patients who received closed-suction drainage had more marked reductions in haematocrit (10.4 vs. 7.4, p=0.03).…”