Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial

Abstract

The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (= 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (= 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

“…After abdominal surgery (laparotomy), Higson et al found a duplication of infection using non-aspirating drainage, whereas other studies did not confirm this association [25]. Drains can generally lead to a reduction in pain after surgeries such as total knee arthroplasty, but the results in this randomized prospective study were only confirmed in the early-term but not long-term follow-up [17]. However, in considering the postoperative pain in other disciplines, Schietroma et al found that routine drain placement after thyroidectomy is not necessary, and avoiding drainage was associated with less postoperative pain [44].…”

Closed suction drainage offers no more clinical benefit than non-drainage after primary total knee arthroplasty with the administration of tranexamic acid in Chinese patients

“…However, recent studies showed the otherwise. Multiple clinical trials indicated that CSD offered no additional benefits after TKA [3][4][5]. In addition, many CSD-related side effects, including retrograde infection, increased the loss of blood, and prolonged hospital stay time, were reported [6].…”

Magnesium Sulfate Combined with a Levobupivacaine Periarticular Cocktail for Analgesia in the Early Postoperative Period after Total Knee Arthroplasty

“…The posterior cruciate-stabilizing prostheses were fixed with bone cement, the surface of the patella was not replaced, only the patellar osteophytes were repaired, and the area around the patella was denervated with an electrotome. 5 All drugs were allocated with a sterile syringe in 20 mL increments by surgical personnel unassociated with this study, and the drugs were injected subcutaneously by the surgeon around the posterior knee, medial and lateral collateral ligaments, quadriceps tendon, patellar tendon, and incision edge before suturing. The trial group was administered 20 mL of magnesium sulfate 250 mg þ levobupivacaine 50 mg þ triamcinolone 25 mg þ 0.9% normal saline, and the control group was administered 20 mL of levobupivacaine 50 mg þ triamcinolone 25 mg þ 0.9% normal saline.…”