Skip to main content

Advertisement

SpringerLink
Log in

Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis

  • Review Article
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The clinical use of closed-suction drainage, which aims to reduce postoperative wound haematomas and infection, is common. This study was performed to determine whether closed-suction drainage is safe and effective in promoting wound healing and reducing blood loss and other complications compared with no-drainage in total hip arthroplasty.

Methods

The literature search was based on PubMed, the Cochrane Library, MEDLINE, and EMBASE. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group, and then analysed using RevMan 5.0. Twenty randomised controlled trials involving 3,186 patients were included in our analysis.

Results

The results of our meta-analysis indicate that closed-suction drainage reduces the requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference was observed in the incidence of infection, blood loss, changes in haemoglobin and haematocrit, functional assessment, or other complications when the drainage group was compared with the no-drainage group.

Conclusions

Our results of the comparison between closed-suction drainage and no drainage in THA have indicated that the routine use of closed-suction drainage for elective total hip arthroplasty may be of more harm than benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Holt BT, Parks NL, Engh GA, Lawrence JM (1997) Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty. Orthopedics 20(12):1121–1124, discussion 1124–1125

    Google Scholar 

  2. Sundaram RO, Parkinson RW (2007) Closed suction drains do not increase the blood transfusion rates in patients undergoing total knee arthroplasty. Int Orthop 31(5):613–616

    Article  Google Scholar 

  3. Beer KJ, Lombardi AV Jr, Mallory TH, Vaughn BK (1991) The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am 73(4):584–587

    Google Scholar 

  4. Murphy JP, Scott JE (1993) The effectiveness of suction drainage in total hip arthroplasty. J R Soc Med 86(7):388–389

    Google Scholar 

  5. 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(1):35–38

    Google Scholar 

  6. Ovadia D, Luger E, Bickels J, Menachem A, Dekel S (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12(3):317–321

    Article  Google Scholar 

  7. O'Brien S, Engela D, James P, Kernohan G, Connolly D, Milligan K, Kettle P, Beverland D (1997) The use of wound drains in total hip replacement surgery. J Orthop Nursing 1:77–83

    Google Scholar 

  8. Crevoisier XM, Reber P, Noesberger B (1998) Is suction drainage necessary after total joint arthroplasty? A prospective study. Arch Orthop Trauma Surg 117(3):121–124

    Article  Google Scholar 

  9. Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. J Arthroplasty 13(2):156–161

    Article  Google Scholar 

  10. Niskanen RO, Korkala OL, Haapala J, Kuokkanen HO, Kaukonen JP, Salo SA (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 15(5):567–569

    Article  Google Scholar 

  11. Ravikumar KJAT, Fordyce MJF, Tuson KWR (2001) Drainage versus nondrainage in total hip arthroplasty. A prospective randomised study. Hip Int 11:49–53

    Google Scholar 

  12. Widman J, Jacobsson H, Larsson SA, Isacson J (2002) No effect of drains on the postoperative hematoma volume in hip replacement surgery: a randomized study using scintigraphy. Acta Orthop Scand 73(6):625–629

    Google Scholar 

  13. RMF H, I B. (2003) Drain vs no drain in unilateral total hip arthroplasty: a randomised prospective trial [abstract]. J Bone Joint Surg Br 85(Suppl II):104

    Google Scholar 

  14. Gonzalez Della Valle A, Slullitel G, Vestri R, Comba F, Buttaro M, Piccaluga F (2004) No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations. Acta Orthop Scand 75–1:30–33

    Article  Google Scholar 

  15. Johansson T, Engquist M, Pettersson LG, Lisander B (2005) Blood loss after total hip replacement: a prospective randomized study between wound compression and drainage. J Arthroplasty 20(8):967–971

    Article  Google Scholar 

  16. Walmsley PJ, Kelly MB, Hill RM, Brenkel I (2005) A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br 87(10):1397–1401

    Google Scholar 

  17. Dora C, von Campe A, Mengiardi B, Koch P, Vienne P (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(10):919–923

    Article  Google Scholar 

  18. Cheung G, Carmont MR, Bing AJF, Kuiper JH, Alcock RJ, Graham NM (2010) No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients. Acta Orthopaedica Belgica 76(5):619–627

    Google Scholar 

  19. Strahovnik A, Fokter SK, Kotnik M (2010) Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty. J Arthroplasty 25(2):244–248

    Article  Google Scholar 

  20. Kleinert K, Werner C, Mamisch-Saupe N, Kalberer F, Dora C (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(1):131–136

    Article  Google Scholar 

  21. von Roth P, Perka C, Dirschedl K, Mayr HO, Ensthaler L, Preininger B, Hube R (2012) Use of Redon drains in primary total hip arthroplasty has no clinically relevant benefits. Orthopedics 35(11):e1592–e1595

    Article  Google Scholar 

  22. Matsuda K, Nakamura S, Wakimoto N, Kobayashi M, Matsushita T (2007) Drainage does not increase anemia after cementless total hip arthroplasty. Clin Orthop Relat Res 458:101–105

    PubMed  Google Scholar 

  23. Parker MJ, Livingstone V, Clifton R, McKee A (2007) Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev 3:CD001825

    PubMed  Google Scholar 

  24. Higgins JPT (2008) Cochrane handbook for systematic reviews of interventions, version 5.0.1 [updated September 2008]. The Cochrane Collaboration. Available from www.cochrane-handbook.org. Accessed 31 July 2013

  25. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336

    Article  PubMed  Google Scholar 

  26. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539

    Article  PubMed  Google Scholar 

  27. Snell S (1876) On the suction-operation for cataract. Br Med J 1–802:595

    Article  Google Scholar 

  28. Howe L (1893) On the removal of hard cataract by suction. Trans Am Ophthalmol Soc 6:594–596

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank Professor Martyn Parker, Dr. Ling-ling Sun and Dr. Tiao Lin for help in this study.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedics Surgery, The Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China

    Xin-die Zhou, Jin Li, Yan Xiong, Li-feng Jiang, Wei-jun Li & Li-dong Wu

Authors
  1. Xin-die Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li-feng Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei-jun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Li-dong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li-dong Wu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhou, Xd., Li, J., Xiong, Y. et al. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. International Orthopaedics (SICOT) 37, 2109–2118 (2013). https://doi.org/10.1007/s00264-013-2053-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-2053-8

Keywords

Search

Navigation