Efficacy of closed wound drainage after total joint arthroplasty

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

“…Allogenic blood transfusion was performed if hemoglobin decreased to less than 7.0 mg/dL or if anemic symptoms developed, such as a decrease in blood pressure to less than 100 mmHg, tachycardia greater than 100 beats/minute, or a low urine output less than 30 mL/hour, even after volume replacement with 500 mL normal saline in patients with a hemoglobin level between 7.0 and 8.0 mg/dL [29,32]. Allogenic transfusion was not performed when the hemoglobin level was greater than 8.0 mg/dL.…”

“…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].…”

“…There are two schools of thought regarding the use of vacuum drainage after TKA: to use indwelling vacuum drainage in the intraarticular space [18,22,29,44] or to not use any form of vacuum drainage [1,3,10,15,20,23,28,30,35,36]. Intraarticular placement of a vacuum drain can reduce undesirable blood accumulation and thus prevent intraarticular or subcutaneous hematoma formation [18,22,29,30].…”

“…Intraarticular placement of a vacuum drain can reduce undesirable blood accumulation and thus prevent intraarticular or subcutaneous hematoma formation [18,22,29,30]. However, it can increase blood loss and induce circulatory instability owing to acute blood drainage through the drainage system, which increases the likelihood of postoperative blood transfusion [15,20,[28][29][30]35]. However, the nonuse of an indwelling vacuum drain, owing to a tamponade effect, can reduce total blood loss but also can increase bleeding into dressings and cause wound complications [18,22,29,30].…”

“…However, it can increase blood loss and induce circulatory instability owing to acute blood drainage through the drainage system, which increases the likelihood of postoperative blood transfusion [15,20,[28][29][30]35]. However, the nonuse of an indwelling vacuum drain, owing to a tamponade effect, can reduce total blood loss but also can increase bleeding into dressings and cause wound complications [18,22,29,30]. Therefore, both approaches have limitations, and the issue of vacuum drainage after TKA remains a matter of debate.…”