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

Abstract

Background: If closed suction drainage (CSD) should be used after primary total knee arthroplasty (TKA), remains controversial. The current study aimed to explore whether CSD offers more clinical benefit with the administration of tranexamic acid in Chinese patients. Methods: A retrospective study was conducted on 200 patients who had received TKA. One hundred patients were placed on drainage after TKA, whereas the rest of 100 patients were not. Multiple clinical parameters were dynamically monitored and compared between the two groups. Results: The length of the hospitalization days was significantly shorter in patients who did not receive CSD (6.0 ± 0.8 vs. 7.0 ± 0.8 days, p < 0.001). The patients in the drainage group had more Hb drop on the first postoperative day (14.82 ± 6.58 vs. 11.27 ± 5.71 g/L, p < 0.001). No statistically significant difference was observed in VAS score, ROM and thigh circumference at baseline during the follow-up between two groups.Conclusions: Additional drainage after primary TKA had no clinical benefit after the tranexamic acid had already been administered during the treatment.

Non-drainage Offers Faster Proprioceptive and Functional Recovery, and More Clinical Benefits for Patients following Primary Total Knee Arthroplasty Compared to Drainage

“…The most important finding of the current study was that the nondrainage procedure yielded greater enhancements in pain, functioning, and proprioception compared to drainage. Our findings agree with those of previous studies [7,8,9,10,11] that have advocated for the use of the non-drainage procedure rather than drainage to provide better postoperative outcomes following TKA. Nonetheless, these previous studies mostly focused on measuring the influence of drainage on clinical outcomes such as pain level, ROM, infection rate.…”

“…The perioperative blood loss management we used may have led to the same level of hematoma effusion, and therefore, the same level of knee swelling and ROM in both groups of the current study. Placement and removal of a drainage tube, which undoubtedly extends the duration of the inflammatory process [8,10], can be painful for patients at an early postoperative stage. More, the presence of drainage can be irritating for patients who received drainage, and therefore may excite patients' fear of drainage, and eventually exacerbate their perception of pain.…”

“…Functional recovery level following joint arthroplasty provides significant information about the healing process [13]. Regarding the knee joint function, previous studies reported no differences between drainage and non-drainage, or superiority of non-drainage based on their measures such as knee ROM, knee pain, and ASLR [7,8,10]. Nonetheless, these outcome measures do not directly reflect the functional recovery of TKA patients.…”

“…On the other hand, current literature demonstrates no added advantages of using drainage following TKA related to postoperative clinical outcomes [3,5]. Moreover, some studies reported that the use of drainage is associated with greater blood loss, a higher infection rate, and severe pain, and therefore drainage hinders early ambulation and the postoperative rehabilitation process [7,8,9,10,11]. Nevertheless, drainage is frequently applied by many orthopedic surgeons in their TKA operation, despite controversies in the current literature [12].…”

The necessity of suction drainage when intra-articular injection of tranexamic acid is used during primary total knee arthroplasty: a retrospective study

“…Regarding the incidence of DVT, Huang et al reported that in a study of 92 TKA knees with intravenous TXA, ultrasonography was performed on postoperative days 1 and 3 and at discharge, and DVT occurred in 1.1% of patients [ 31 ]. However, in reports of TKA with TXA, ultrasound was performed only when DVT was suspected [ 10 , 16 , 18 , 21 , 32 ]. Ito et al performed ultrasounds on postoperative day 7 in all patients in TKA without TXA administration and reported an overall incidence of DVT of 31.6% with a proximal incidence of 2.5% [ 33 ], similar to the results of the present study.…”