Closed suction drains, reinfusion drains or no drains in primary total knee replacement?

Abstract

INTRODUCTIONControversy still surrounds the use of drains after total knee replacement (TKR). We compared closed suction drains, reinfusion drains and no drains by studying haemoglobin (Hb) levels, blood transfusion requirements and functional knee outcome scores in a single surgeon series.METHODSA total of 102 consecutive primary TKRs were performed by the senior author between September 2006 and July 2008. All were cemented fixed bearing devices with patellar resurfacing. Of the 102 patients, 30 had closed suction drainage, 33 had an unwashed reinfusion drainage system and 39 had no drains. Data regarding pre and post-operative Hb and units transfused were gathered retrospectively. Pre and post-operative American Knee Society scores (AKSS) and Oxford knee scores (OKS) were recorded prospectively.RESULTSThe pre-operative Hb levels were comparable among the groups. There was no statistically significant difference in Hb level reduction or autologous transfusion rates among the groups. Pre-operative AKSS and OKS were statistically comparable in each group. There was no statistical difference between the improvement in AKSS knee and function scores in all three groups. There was a slightly smaller improvement in the OKS of the ‘no drain’ group. There were no complications of drain usage and no deep infections. No patient required manipulation under anaesthesia and range of movement outcomes were the same for each group.CONCLUSIONSOur study does not support the use of either closed suction drains or reinfusion drains in primary elective TKR.

What Is the Benefit of Tranexamic Acid vs Reinfusion Drains in Total Joint Arthroplasty?

“…The data on their efficacy has been somewhat [15,16]. However, another randomized controlled study on the use of reinfusion systems in THA and TKA found a statistically significant reduction in allogenic blood transfusion when the reinfusion system was used (6%), compared to the control group (19% p=0.015) [17].…”

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

“…6 Similarly, Al-Zahid et al found no benefit with the use of post-operative closed-suction or re-infusion drains following primary, elective TKA. 5 These results seem to suggest drains may not be warranted following lower extremity arthroplasty, and as such, it is necessary to determine if these drains are necessary following shoulder arthroplasty.…”

“…There have been several studies following total and unicompartmental knee arthroplasty as well as total hip arthroplasty that have evaluated the use of post-operative closed-suction drains. [5][6][7] While many surgeons still routinely use post-operative drains following total knee arthroplasty (TKA), the data suggests this is unnecessary. Bjerke-Kroll et al reviewed the use of post-operative drains in patients following 598 TKA and 536 total hip arthroplasties (THA).…”

Does Draining the Post Operative Hematoma Have an Impact in Tka Patients

“…Moreover post operative drain usage in TKA is associated with an astounding increase in cost of over $400 per knee in a recent study [4]. Al-Zahid [5] in his study on over a hundred TKAs found no significant difference in terms of wound complications, blood loss and functional outcome. A Polish study also favored not to use drains post operatively as authors noticed lesser number of dressing change during hospitalization and also lower need of opioid analgesia [6].…”