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Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 11, pp 1623–1631 | Cite as

Comparison between autologous blood transfusion drainage and no drainage/closed-suction drainage in primary total hip arthroplasty: a meta-analysis

  • Ning Li
  • Peng Li
  • Ming Liu
  • Dan Wang
  • Lei Xia
Hip Arthroplasty

Abstract

Purpose

Primary aim of this meta-analysis of randomized controlled trials (RCTs) was to compare blood loss, transfusion rate and postoperative hemoglobin levels at 24–48 h after primary total hip arthroplasty (THA) between autologous blood transfusion (ABT) drainage and no drainage/closed-suction drainage and to obtain a powerful conclusion which way of drainage had the best clinical efficacy. Secondary aim was to compare the postoperative complication rates during the first year to indentify which way of drainage was safest.

Methods

We searched the PubMed, Embase and Cochrane Central Register of Controlled Trials and identified 12 RCTs (including a total of 1,574 patients) for the meta-analysis. Methodological quality was assessed by the Physiotherapy Evidence Database scale. Two researchers extracted relevant data including study characteristics, blood loss, transfusion rate, hemoglobin levels, hospital stay and complications. After data extraction, we compared results using fixed-effects or random-effects models depending on the heterogeneity of the included studies.

Results

Autologous blood transfusion drainage had less total blood loss and lower superficial infection rate than no drainage/closed-suction drainage. While there were no statistical differences in postoperative pain, hematoma, hemoglobin levels, hospital stay and other complications between ABT drainage and no drainage/closed-suction drainage.

Conclusions

Autologous blood transfusion drainage and no drainage/closed-suction drainage have similar clinical efficacy and safety in primary THA with regard to clinical outcomes and complication rates.

Keywords

Drainage Closed-suction drainage ABT drainage Total hip arthroplasty 

Notes

Acknowledgments

We would like to thank Ms Jing Zhu for her help in this study.

Conflict of interest

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

References

  1. 1.
    Beer KJ, Lombardi AV Jr, Mallory TH et al (1991) The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am 73:584–587PubMedGoogle Scholar
  2. 2.
    Horstmann WG, Swierstra MJ, Ohanis D et al (2014) Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial. Int Orthop 38:13–18PubMedCrossRefGoogle Scholar
  3. 3.
    Ovadia D, Luger E, Bickels J et al (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12:317–321PubMedCrossRefGoogle Scholar
  4. 4.
    Niskanen RO, Korkala OL, Haapala J et al (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 15:567–569PubMedCrossRefGoogle Scholar
  5. 5.
    Smith LK, Williams DH, Langkamer VG (2007) Post-operative blood salvage with autologous retransfusion in primary total hip replacement. J Bone Joint Surg Br 89:1092–1097PubMedCrossRefGoogle Scholar
  6. 6.
    Grosvenor D, Goyal V, Goodman S (2000) Efficacy of postoperative blood salvage following total hip arthroplasty in patients with and without deposited autologous units. J Bone Joint Surg Am 82-A:951–954PubMedGoogle Scholar
  7. 7.
    Strumper D, Weber EW, Gielen-Wijffels S et al (2004) Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty. Transfusion 44:1567–1571PubMedCrossRefGoogle Scholar
  8. 8.
    Zhou XD, Li J, Xiong Y et al (2013) Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37:2109–2118PubMedCrossRefGoogle Scholar
  9. 9.
    de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55:129–133PubMedCrossRefGoogle Scholar
  10. 10.
    Verhagen AP, de Vet HC, de Bie RA et al (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241PubMedCrossRefGoogle Scholar
  11. 11.
    Ma J, Liu W, Hunter A et al (2008) Performing meta-analysis with incomplete statistical information in clinical trials. BMC Med Res Methodol 8:56PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. J Arthroplasty 13:156–161PubMedCrossRefGoogle Scholar
  14. 14.
    Murphy JP, Scott JE (1993) The effectiveness of suction drainage in total hip arthroplasty. J R Soc Med 86:388–389PubMedPubMedCentralGoogle Scholar
  15. 15.
    Ritter MA, Keating EM, Faris PM (1994) Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 76:35–38PubMedGoogle Scholar
  16. 16.
    Crevoisier XM, Reber P, Noesberger B (1998) Is suction drainage necessary after total joint arthroplasty? A prospective study. Arch Orthop Trauma Surg 117:121–124PubMedCrossRefGoogle Scholar
  17. 17.
    Cheung G, Carmont MR, Bing AJ et al (2010) No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients. Acta Orthop Belg 76:619–627PubMedGoogle Scholar
  18. 18.
    Dora C, von Campe A, Mengiardi B et al (2007) Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations. Arch Orthop Trauma Surg 127:919–923PubMedCrossRefGoogle Scholar
  19. 19.
    González Della Valle A, Slullitel G, Vestri R et al (2004) No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations. Acta Orthop Scand 75:30–33PubMedCrossRefGoogle Scholar
  20. 20.
    Horstmann WG, Kuipers BM, Slappendel R et al (2012) Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial. Int Orthop 36:2033–2039PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Kleinert K, Werner C, Mamisch-Saupe N et al (2012) Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach. Arch Orthop Trauma Surg 132:131–136PubMedCrossRefGoogle Scholar
  22. 22.
    Matsuda K, Nakamura S, Wakimoto N et al (2007) Drainage does not increase anemia after cementless total hip arthroplasty. Clin Orthop Relat Res 458:101–105PubMedGoogle Scholar
  23. 23.
    Strahovnik A, Fokter SK, Kotnik M (2010) Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty. J Arthroplasty 25:244–248PubMedCrossRefGoogle Scholar
  24. 24.
    Walmsley PJ, Kelly MB, Hill RM et al (2005) A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br 87:1397–1401PubMedCrossRefGoogle Scholar
  25. 25.
    Widman J, Jacobsson H, Larsson SA et al (2002) No effect of drains on the postoperative hematoma volume in hip replacement surgery: a randomized study using scintigraphy. Acta Orthop Scand 73:625–629PubMedGoogle Scholar
  26. 26.
    Johansson T, Engquist M, Pettersson LG et al (2005) Blood loss after total hip replacement: a prospective randomized study between wound compression and drainage. J Arthroplasty 20:967–971PubMedCrossRefGoogle Scholar
  27. 27.
    Horstmann WG, Swierstra MJ, Ohanis D et al (2013) Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement. Bone Joint J 95B:616–622CrossRefGoogle Scholar
  28. 28.
    Schneider MM, Kendoff D, Oloughlin PF et al (2014) Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty. Technol Health Care 22:123–128PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of OrthopedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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