The Use of Postoperative Suction Drainage in Total Knee Arthroplasty

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

“…First, we did not include a group without closed-suction drainage, and therefore, we cannot conclude from this study whether intraarticular or subcutaneous closed drainage offers advantages or disadvantages in comparison to no drain. Furthermore, despite the lack of definitive proof regarding the advantages of vacuum drainage [1,3,10,15,20,23,28,30,35,36], many surgeons continue to use vacuum drainage after TKA to reduce the possibility of wound problems and the need for dressing reinforcement [7,18,22,29,30]. Our data showed that a subcutaneous closed suction drain resulted in outcomes equivalent to those of an intraarticular closed suction drain but, having no control group without a drain, could not address the value of either drainage method versus no drain.…”

“…However, this modality has the disadvantage of increasing blood loss [7,18,22,29,30,44]. In contrast, some surgeons favor not placing an indwelling vacuum drain to avoid increased blood loss [1,3,10,15,20,23,28,30,35,36], although this strategy increases the risk of wound problems and the need for more frequent dressing reinforcement [18,22,29,30]. We hypothesized that subcutaneous closed-suction drainage would be a potentially efficacious alternative to either intraarticular closedsuction drainage or no drain because it could exploit the advantages of both methods, namely, the drainage and the joint tamponade effects.…”

“…There are two schools of thought regarding the use of vacuum drainage after TKA: to use indwelling vacuum drainage in the intraarticular space [18,22,29,44] or to not use any form of vacuum drainage [1,3,10,15,20,23,28,30,35,36]. Intraarticular placement of a vacuum drain can reduce undesirable blood accumulation and thus prevent intraarticular or subcutaneous hematoma formation [18,22,29,30].…”

“…Intraarticular placement of a vacuum drain can reduce undesirable blood accumulation and thus prevent intraarticular or subcutaneous hematoma formation [18,22,29,30]. However, it can increase blood loss and induce circulatory instability owing to acute blood drainage through the drainage system, which increases the likelihood of postoperative blood transfusion [15,20,[28][29][30]35]. However, the nonuse of an indwelling vacuum drain, owing to a tamponade effect, can reduce total blood loss but also can increase bleeding into dressings and cause wound complications [18,22,29,30].…”

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

“…T he benefits of surgical drainage have been recognized since the time of Hippocrates [1][2][3][4]. As stated by Dougherty and Simmons in their extensive 1992 review of drainage tactics, drains serve to ''prevent or evacuate accumulations of fluid or gas'' [5].…”