Skip to main content
SpringerLink
Log in

The use of postoperative suction drainage in total knee arthroplasty: a systematic review

International Orthopaedics volume 39, pages 653–658 (2015)Cite this article

Abstract

Purpose

The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, length of hospital stay and haemoglobin levels following TKA.

Methods

Six randomised controlled trials were included.

Results

There is no significant difference between the individuals who receive a drain and those who do not across any of the measures examined (p < 0.05). This analysis demonstrates no statistical difference in ROM [mean difference 0.03° (95 %CI −1.51 to 1.45, p = 0.64, I2 = 0 %)].

, nor in knee circumference [mean difference 1.63 cm (95 % CI −1.07 – 4.34 cm, p = 0.34), [I2 = 0.12].

Conclusion

The finding raises the possibility that drains are not required to assist in recovery following TKA.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

References

  1. Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E (2005) Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg (Am) 87:1222–1228

    Article  Google Scholar 

  2. National Joint Registry UK (2014) Statistics. http://www.njrcentre.org.uk. Accessed 9 July 2014

  3. NIH (2003) NIH consensus statement on total knee replacement. NIH Consensus Statements. Dec 8–10;20(1):1–34

  4. Waugh TB, Stinchfield FE (1961) Suction drainage of orthopaedic wounds. J Bone Joint Surg Am 43-A:939–946

    CAS  PubMed  Google Scholar 

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

  6. Minnema B, Vearncombe M, Augustin A, Gollish J, Simor AE (2004) Risk factors for surgical-site infection following primary total knee arthroplasty. Infect Control Hosp Epidemiol 25(6):477–480

    Article  PubMed  Google Scholar 

  7. Overgaard S, Thomsen NO, Kulinski B, Mossing NB (1993) Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand 64(4):417–420

    Article  CAS  PubMed  Google Scholar 

  8. Corpe RS, Gallentine JW, Young TR, Steflik DE, Rectinwald EJ, Kusuma S (2000) Complications in total knee arthroplasty with and without surgical drainage. J South Orthop Assoc Fall 9(3):207–212

    CAS  Google Scholar 

  9. Omonbude D, El Masry MA, O’Connor PJ, Grainger AJ, Allgar VL, Calder SJ (2010) Measurement of joint effusion and haematoma formation by ultrasound in assessing the effectiveness of drains after total knee replacement: A prospective randomised study. J Bone Joint Surg (Br) 92(1):51–55

    Article  CAS  Google Scholar 

  10. Esler CN, Blakeway C, Fiddian NJ (2003) The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg (Br) 85(2):215–217

    Article  CAS  Google Scholar 

  11. Jenny J-Y, Boeri C, Lafare S (2001) No drainage does not increase the complication risk after total knee prosthesis implantation: a prospective, comparative, randomised study. Knee Surg Sports Traumatol Arthrosc 9:299–301

    Article  CAS  PubMed  Google Scholar 

  12. Adalberth G, Byström S, Kolstad K, Mallmin H, Milbrink J (1998) Postoperative drainage of knee arthroplasty is not necessary: a randomized study of 90 patients. Acta Orthop Scand 69(5):475–478

    Article  CAS  PubMed  Google Scholar 

  13. Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res 347:188–193

    PubMed  Google Scholar 

  14. 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 1124–5

    CAS  PubMed  Google Scholar 

  15. Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A(6):1146–1152

    PubMed  Google Scholar 

  16. Clifton R, Haleem S, McKee A, Parker MJ (2008) Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials. Int Orthop 32(6):723–727

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. PRISMA (2014) Prisma guidelines. http://www.prisma-statement.org/statement.htm. Accessed 9 July 2014

  18. Mengal B, Aebi J, Rodriguez A, Lemaire R (2001) A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 87(1):29–39

    CAS  PubMed  Google Scholar 

  19. Cobb JP (1990) Why use drains? J Bone Joint Surg (Br) 72:993–995

    CAS  Google Scholar 

  20. Canty SJ, Shepard GJ, Ryan WG, Banks AJ (2003) Do we practice evidence based medicine with regard to drain usage in knee arthroplasty? Results of a questionnaire of BASK members. Knee 10(4):385–387

    Article  CAS  PubMed  Google Scholar 

  21. Kumar S, Penematsa S, Parekh S (2007) Are drains required following a routine primary total joint arthroplasty? Int Orthop 31(5):593–596

    Article  PubMed Central  PubMed  Google Scholar 

  22. Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E (2002) Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 20(3):506–515

    Article  PubMed  Google Scholar 

  23. Zamora-Navas P, Collado-Torres F, de la Torre-Solís F (1999) Closed suction drainage after knee arthroplasty. A prospective study of the effectiveness of the operation and of bacterial contamination. Acta Orthop Belg 65(1):44–47

    CAS  PubMed  Google Scholar 

  24. Greidanus NV, Peterson RC, Masri BA, Garbuz DS (2011) Quality of life outcomes in revision versus primary total knee arthroplasty. J Arthroplasty 26(4):615–620

  25. Cao L, Ablimit N, Mamtimin A, Zhang KY, Li GQ, Li G, Peng LB (2009) Comparison of no drain or with a drain after unilateral total knee arthroplasty: a prospective randomized controlled trial. Zhonghua Wai Ke Za Zhi 47(18):1390–1393

    PubMed  Google Scholar 

  26. Lin J, Fan Y, Chang X, Wang W, Weng XS, Qiu GX (2009) Comparative study of one stage bilateral total knee arthroplasty with or without drainage. Zhonghua Yi Xue Za Zhi 89(21):1480–1483

    PubMed  Google Scholar 

  27. Tao K, Wu HS, Li XH, Qian QR, Wu YL, Zhu YL, Chu XB, Xu CM (2006) The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study. Zhonghua Wai Ke Za Zhi 44(16):1111–1114

    PubMed  Google Scholar 

  28. Martin A, Prenn M, Spiegel T, Sukopp C, von Strempel A (2004) Relevance of wound drainage in total knee arthroplasty—a prospective comparative study. Z Orthop Ihre Grenzgeb 142(1):46–50

    Article  CAS  PubMed  Google Scholar 

  29. Seyfert C, Schulz K, Pap G (2002) The influence of the drain suction in knee arthroplasty. [Article in German] Zentralbl Chir 127(10):886–889

  30. Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD (2013) Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37(11):2109–2118. doi:10.1007/s00264-013-2053-8

    Article  PubMed Central  PubMed  Google Scholar 

  31. Zhou XD, Wu LD (2013) Reply to Comment on Zhou et al.: Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37(12):2531–2532. doi:10.1007/s00264-013-2125-9

    Article  PubMed Central  PubMed  Google Scholar 

  32. Zhang S, Guo T, Zhao J (2013) Comment on Zhou et al.: Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37(12):2529. doi:10.1007/s00264-013-2124-x

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

No competing interests have been declared.

Author information

Authors and Affiliations

  1. Professorial Unit, National Orthopaedic Hospital, Cappagh, Finglas, Dublin 11, Republic of Ireland

    Mark Quinn, Andrea Bowe, Peter Dawson & John O’Byrne

  2. HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Republic of Ireland

    Rose Galvin

Authors
  1. Mark Quinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Bowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rose Galvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Dawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John O’Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Bowe.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Quinn, M., Bowe, A., Galvin, R. et al. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. International Orthopaedics (SICOT) 39, 653–658 (2015). https://doi.org/10.1007/s00264-014-2455-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2455-2

Keywords

search

Navigation