Do we practice evidence based medicine with regard to drain usage in knee arthroplasty? Results of a questionnaire of BASK members

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

“…First, we did not include a group without closed-suction drainage, and therefore, we cannot conclude from this study whether intraarticular or subcutaneous closed drainage offers advantages or disadvantages in comparison to no drain. Furthermore, despite the lack of definitive proof regarding the advantages of vacuum drainage [1,3,10,15,20,23,28,30,35,36], many surgeons continue to use vacuum drainage after TKA to reduce the possibility of wound problems and the need for dressing reinforcement [7,18,22,29,30]. Our data showed that a subcutaneous closed suction drain resulted in outcomes equivalent to those of an intraarticular closed suction drain but, having no control group without a drain, could not address the value of either drainage method versus no drain.…”

“…Many surgeons place vacuum drainage to avoid bleeding-related complications, such as hemarthrosis, which allegedly is associated with increased infection, delayed rehabilitation, and wound-healing problems. However, this modality has the disadvantage of increasing blood loss [7,18,22,29,30,44]. In contrast, some surgeons favor not placing an indwelling vacuum drain to avoid increased blood loss [1,3,10,15,20,23,28,30,35,36], although this strategy increases the risk of wound problems and the need for more frequent dressing reinforcement [18,22,29,30].…”

“…In addition, excessive bleeding may lead to intraarticular or subcutaneous hematoma formation, which can impair wound healing, restrict mobilization, and increase the risk of deep infection [18,22,31]. Vacuum drainage is commonly used after TKA with the intent of preventing intraarticular or subcutaneous hematoma formation and thus decreasing the likelihood of delayed recovery of motion arc, prolonged drainage, and wound infection [7,18,22,29,30,44].…”

The Role of Drainage After Total Knee Arthroplasty

“…However, a closed suction drainage system inevitably increases bleeding because the tamponade effect of a closed and undrained wound is eliminated. Though some studies have shown that drainage after TKA is not necessary (Adalberth et al 1998;Niskanen et al 2000;Esler et al 2003;Parker et al 2004;Jones et al 2007), it is still widely used by orthopedic surgeons (Canty et al 2003). Surgeons who routinely drain total knee replacements may also use adjunctive measures such as autologous blood transfusion, use of fibrin tissue adhesive, compression bandaging and local ice packing (Gibbons et al 2001;Kullenberg et al 2006;Radkowski et al 2007) to reduce the excessive blood loss from the drain.…”

Blood Transfusion in Knee Arthroplasty

“…Its use prevents postoperative hematomas and diminishes postoperative pain, but its use is still controversial (Corpe et al, 2000). Despite several evidence-based medical studies, British orthopedists were not following their recommendations in 2003 (Canty et al, 2003). Drains have been related to the transfusion necessity and infection rate, among others.…”