New strategy of closed suction drainage after primary total hip arthroplasty

Lee, Gun-Woo; Park, Kyung-Soon; Kim, Doyoun; Shin, Young-Rok; Yoon, Tae Mi

doi:10.1016/j.aott.2017.02.010

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…Yang [ 23 ] is indeed the article with high heterogeneity in pain scoring studies on the second and third postoperative days, but its study design did not differ significantly from other studies, in which case we would consider whether this is due to demographic differences or measurement error. And the reason why Lychagin brings 99% heterogeneity in hct level results may be due to the use of CSD, which exacerbates blood loss and therefore has a significant effect on this indicator [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis

Yang

Yan

Niu

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. To synthesize the evidence regarding the effect and safety of drainage after the hip arthroplasty in randomized control trials. Background. Although the standard of hip replacement has matured in recent years, the need for postoperative drainage is still controversial which also is a clinical problem that needs to be addressed. Design. A systematic review and meta-analysis based on the Cochrane methods and Prisma guideline. Data Resources. A systematic search of the Cochrane Library, PubMed, EMBASE, CINAHL, Ovid, Wan Fang database, CNKI, and CBM database was carried out from January 1, 2000, to December, 2021. Review Methods. The quality of included randomized controlled trials was assessed individually by two reviewers independently using criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results. Nineteen randomized control trials involving 3354 participants were included in this analysis. From the above analysis, we can know that compared with nondrainage, there was a statistically significant difference in VAS score on the postoperative first day ( SD = − 0.6 ; 95% CI: -0.79, -0.41) and second day ( SD = − 0.38 , 95% CI: -0.58, -0.18), hematocrit reduction (MD =2.89; 95% CI: 1.3, 4.48), blood transfusion rate (OR =1.47; 95% CI: 1.12, 1.92), change of thigh circumstance ( SMD = − 0.48 ; 95% CI: -0.66, -0.31), and hospital stay ( MD = 1.06 ; 95% CI: 0.73, 1.39) in drainage. However, there were no statistically significant differences in hemoglobin and hematocrit level, hip function, total blood loss, transfusion volume, dressing use, and complications between them. Conclusion. Drainage after hip arthroplasty can reduce swelling in the thigh and relieve pain while no drainage can bring down hematocrit reduction, decrease dressing uses, and shorten the hospital stay which promotes rapid recovery. This review provides a detailed theoretical reference for the proper clinical application of drains and improves the efficient use of resources.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis

Yang

Yan

Niu

et al. 2022

Computational and Mathematical Methods in Medicine

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“…5 As already concluded in previous studies on smaller patient populations and summarizing our results, the slight improvement in the short-term post-surgical pain level does not justify the use of a drain when taking the increased risk of blood transfusion into consideration. 7,8…”

Section: Discussionmentioning

confidence: 99%

“…5 Reports on the efficiency of wound drainage following THA are contradicted by others showing additional risks of this practice. 6–8…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the potential complications of surgical wound drainage in primary total hip arthroplasty: a prospective controlled double-blind study

2020

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Background: The routine use of postoperative wound drainage following total hip arthroplasty (THA) to avoid the creation of excessive haematomas is controversial because of the potential risk of blood loss and wound infection. Methods: In a prospective double-blind controlled study, 2 groups of patients with hip joint osteoarthritis were operated with primary THA, 1 with surgical wound negative pressure drainage (Group 1 – 635 patients) and the other without (Group 2 – 527 patients). Postoperative blood haemoglobin and haematocrit levels, the necessity for blood transfusion, values of the potential infection markers (serum C-reactive protein values and erythrocyte sedimentation rate), postoperative pain level (according to the VAS scale) and functional outcome (according to Harris Hip Score [HHS] and SF-36 scores) at 12 months postoperatively were compared. Results: A significantly higher drop in blood haemoglobin and haematocrit values was observed in the Group 1 patients (mean drop of 2.2 gr/dl ± 0.25 vs. 1.6 gr/dl ± 0.35 and mean drop of 16% ± 4.0 vs. 11% ± 3.0, respectively, p < 0.01, paired t test). The need for blood transfusion was significantly higher in the Group 1 patients (4.9% vs. 3.9%, p < 0.05, t test). The severity of pain (VAS scale) on the first day after the operation was significantly lower in the Group 1 patients ( p < 0.05, t test), but overall, in both groups it was of low intensity (VAS <3). A similar postoperative wound infection rate was observed in both groups (0.4%). HHS and SF-36 scores were similar in both groups. Conclusions: The drainage of surgical wounds following primary THA due to hip osteoarthritis has a low added value and might cause an increased requirement for blood transfusion.

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“…Unfortunately, the drainage tube is also a significant portal of entry for infections in the hip. Several studies have documented the risk of infection in the context of prolonged suction drainage [ 4 , 5 ]. These factors encouraged us to perform an analysis to assess the risks of hematoma formation and infection among patients after primary hip replacement according to drainage use.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study

Bartosz

Marczyński

Para

et al. 2021

BMC Musculoskelet Disord

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Background The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis. Methods In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days. Results The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. Conclusions We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings. Trial registration The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.

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New strategy of closed suction drainage after primary total hip arthroplasty

Cited by 6 publications

References 18 publications

Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis

Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis

Evaluation of the potential complications of surgical wound drainage in primary total hip arthroplasty: a prospective controlled double-blind study

Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study

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