Is suction drainage necessary after total joint arthroplasty?

Abstract

A prospective evaluation of 98 patients who had undergone a total hip or knee arthroplasty was conducted to assess the effect of postoperative suction drainage. Sixty-six patients undergoing elective total hip arthroplasty and 32 patients undergoing total knee replacement were randomly allocated to undergo either suction drainage or no drainage of the wound. Statistical analysis of the results showed no difference in wound healing, severity of wound haematoma, postoperative blood transfusion requirement, range of motion and duration of the hospitalization between the two groups. We conclude that the use of closed suction drainage provides no apparent advantage after uncomplicated total hip or knee arthroplasty.

Comment on Kumar et al.: Are drains required following a routine primary total joint arthroplasty?

“…Other studies on different procedures, e.g. simultaneous bilateral THR [4] or uncemented THR [5], showed similar results in all aspects; which is interesting as it has always been thought that cement reduces the need for transfusion. It looks as though drains have more effect on the need for transfusion than the use of cement.…”

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.…”

“…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]. We hypothesized that subcutaneous closed-suction drainage would be a potentially efficacious alternative to either intraarticular closedsuction drainage or no drain because it could exploit the advantages of both methods, namely, the drainage and the joint tamponade effects.…”

“…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].…”

Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

“…In their views, suction drainage is the best method to get rid of any blood that may accumulate in surgery involving the medullary bone [18]. However, recent studies question the role of drains in uncomplicated orthopaedic operations, and some surgeons consider them unnecessary [1,6,8]. In spite of this controversy, drains are still widely used in orthopaedic surgery.…”