Outcome in primary cemented total knee arthroplasty with or without drain

Kęska, Rafał; Paradowski, Przemysław T.; Witoński, Dariusz

doi:10.4103/0019-5413.136285

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…Opponents of CSD propose that CSD in TJA is associated with greater blood loss because the drain prevents the tamponade effect [6] and because of the higher risk of infection secondary to retrograde bacterial migration [7]. Moreover, some studies [8, 9] also reported that the use of CSD impairs early postoperative rehabilitation and complicates postoperative nursing care.…”

Section: Introductionmentioning

confidence: 99%

Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study

Xie

Lei

et al. 2019

J Orthop Surg Res

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Background In an enhanced recovery after surgery program, not placing a closed suction drain following routine primary total joint arthroplasty (TJA) is becoming more acceptable. However, the influence of drain use on transfusion rate and postoperative length of stay (PLOS) in TJA remains controversial. Therefore, we aimed to compare drain use with no drain in routine primary TJA to determine the differences in transfusion rate and PLOS. Methods We analyzed the data from 12,992 patients undergoing primary unilateral TJA: 6325 total knee arthroplasties (TKA) and 6667 total hip arthroplasties (THA). Patients were divided into two groups according to whether they received a drain postoperatively following TKA and THA. We extracted information for transfusion and PLOS from patients’ electronic health records and analyzed the data by logistic and linear regression analyses. Results The transfusion rate and PLOS were 15.07% and 7.75 ± 3.61 days, respectively, in the drain group and 6.72% and 6.54 ± 3.32 days, respectively, in the no-drain group following TKA. The transfusion rate and PLOS were 20.53% and 7.00 ± 3.35 days, respectively, in the drain group and 13.57% and 6.07 ± 3.06 days, respectively, in the no-drain group following THA. After adjusting for the following variables: age, gender, body mass index, orthopedic diagnoses, hypertension, type 2 diabetes, coronary heart disease, chronic obstructive pulmonary disease, preoperative hemoglobin, albumin, analgesic use, anesthesia, American Society of Anesthesiologists class, tranexamic acid use, intraoperative bleeding, operative time, and tourniquet use (for TKA), drain use correlated significantly with a higher transfusion rate (risk ratio = 2.812, 95% confidence interval (CI) 2.224–3.554, P < 0.001 for TKA and risk ratio = 1.872, 95% CI 1.588–2.207, P < 0.001 for THA) and a longer PLOS (partial regression coefficient ( B ) = 1.099, 95% CI 0.879–1.318, P < 0.001, standard regression coefficient ( B ′) = 0.139 for TKA; B = 0.973, 95% CI 0.695–1.051, P < 0.001, and B ′ = 0.115 for THA). Two groups showed no significant difference in wound complications. Conclusions Our findings indicated that drain use was associated with a higher transfusion rate and a longer PLOS in patients undergoing routine primary TJA. The routine use of postoperative drainage is not recommended in primary unilateral TJA.

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Section: Introductionmentioning

confidence: 99%

Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study

Xie

Lei

et al. 2019

J Orthop Surg Res

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“…The routine use of closed drainage for TKA has been suggested for many decades [ 1 ], but increasing clinical data has failed to show any advantage of postoperative closed drainage [ 18 – 20 ]. Many studies have compared closed drainage with nondrainage TKAs, but most of their samples were too small to allow for definite conclusions, particularly for outcomes with a low prevalence, such as infection [ 5 , 7 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

No clear benefit or drawback to the use of closed drainage after primary total knee arthroplasty: a systematic review and meta-analysis

Yang

Zeng

et al. 2016

BMC Musculoskelet Disord

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BackgroundClosed drainage after primary total knee arthroplasty (TKA) has been used routinely for many decades, but controversies have arisen in recent years. The purposes of this study were to compare the clinical outcomes of closed drainage with nondrainage after primary TKA; and to assess the benefit and drawback of closed drainage.MethodsElectronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for randomised controlled trials (RCTs) that investigated the efficacy and risks of closed drainage after primary TKA. Two investigators independently reviewed studies for eligibility, assessed the risk of bias and extracted the data. A meta-analysis was then performed using Review Manager Software.ResultsTwelve RCTs totalling 889 TKAs were identified. No significant differences in infection rate or blood loss were found between the closed drainage and nondrainage TKAs, and there was also no significant difference in haematoma formation, deep venous thrombosis, postoperative VAS score or range of motion between the two groups.ConclusionsThere appears to be no clear benefit or drawback to the use of closed drainage after primary TKA. Improving the use of closed drainage might provide better outcomes.

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“…While very limited literature is currently available regarding post-operative drain use in TSA or RTSA, there are several studies that have evaluated blood loss, change in hemoglobin, clinical outcomes, and complication rates in TKA and THA between patients who received a post-operative drain and those who did not. [5][6][7][8][9][10] Zhang et al performed a meta-analysis of 15 studies including 1,361 TKA and found that patients with a post-operative drain had less ecchymosis and a decreased need for dressing reinforcement but higher rates of allogeneic blood transfusions than patients without a post-operative drain. The authors also found no differences in post-operative range of motion (ROM) or complication rates including deep venous thrombosis (DVT) or infection between the drain and no drain groups.…”

Section: Discussionmentioning

confidence: 99%

Are Post-Operative Drains Beneficial in Total and Reverse Total Shoulder Arthroplasty?

Erickson¹,

Campbell²,

Jain³

et al. 2016

Orthop Res Traumatol Open J

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CitationErickson BJ, Campbell K, Jain A, et al. Are post-operative drains beneficial in total and reverse total shoulder arthroplasty?. ABSTRACTBackground: Total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are effective treatments for glenohumeral arthritis and rotator cuff arthropathy. Purpose: To determine if the use of a post operative closed-suction drain following TSA and RTSA affects hemoglobin levels, clinical outcomes, and complications. Hypothesis: Patients who did not receive a drain will have less hemoglobin loss, better clinical outcome scores, and lower complication rates following TSA/RTSA. Methods: All patients who underwent TSA or RTSA by one of two surgeons between January 1, 2011 and May 15, 2013 were recorded. Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed. Results: Sixty-four patients (average age 58.9±9.9 years, 55% male) underwent RTSA (13) or TSA (51) without the use of a post-operative closed-suction drain; 304 patients (average age 66.7±9.6 years, 55% female) underwent RTSA (179) or TSA (125) with the use of a post-operative closed-suction drain. Average follow up was similar in both groups: 14.95±7.22 months in the drain group and 14.55±6.74 months in the no drain group (p=.723). Using multivariate analysis to control for confounding variables and differences between the two groups, drain usage was correlated with significantly lower postoperative hemoglobin (p=0.0002), longer length of stay (p≤0.0001), and lower postoperative SST (p=0.003). Conclusion: Closed-suction drain usage following RTSA and TSA leads to greater loss of hemoglobin and longer length of stay. No clinically significant differences in transfusion rate and clinical outcome scores were seen with or without drain usage. LEVEL OF EVIDENCE: III: case-control study.

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Outcome in primary cemented total knee arthroplasty with or without drain

Cited by 11 publications

References 23 publications

Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study

Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study

No clear benefit or drawback to the use of closed drainage after primary total knee arthroplasty: a systematic review and meta-analysis

Are Post-Operative Drains Beneficial in Total and Reverse Total Shoulder Arthroplasty?

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