Skip to main content

Advertisement

SpringerLink
Log in

Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Drainage is a common procedure in high tibial osteotomy (HTO), but the benefits of drainage during HTO remain poorly investigated. This study was designed to investigate the effect of drainage on blood loss and early functional recovery in HTO.

Methods

Altogether, 80 patients undergoing HTO were analyzed from August 2018 to September 2019. Patients were randomized into two groups: group A (drainage, n = 40) and group B (no drainage, n = 40). There were no intergroup differences in baseline parameters between the two groups, and the same surgical techniques and haemostatic methods were used. The mean follow-up time was 3.2 months. Blood loss and early functional recovery of the knee were examined post-operatively in both groups.

Results

The total post-operative blood loss was 253.34 ± 104.18 ml in group A and 222.51 ± 106.89 ml in group B. This difference was non-significant (p > 0.05). The post-operative haemoglobin and haematocrit differences between groups were also non-significant (p > 0.05). Post-operative visual analogue scale (VAS) pain scores and lower leg swelling were lower in group A than those in group B (p < 0.05), and the early range of motion of the knee joint was higher in group A than that in group B (p < 0.05). Group A had lower incidence rates of dressing seepage and incision complications than group B (p < 0.05). The differences in three month post-operative VAS and knee function scores were non-significant (p > 0.05).

Conclusion

Drainage in HTO does not increase patients’ total blood loss, but it can promote early knee function recovery by reducing post-operative pain, lower leg swelling, and the incidence of incision complications.

Trial registration

NCT-03954860

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

Similar content being viewed by others

References

  1. Schuster P, Gesslein M, Schlumberger M, Mayer P, Mayr R, Oremek D, Frank S, Schulz-Jahrsdorfer M, Richter J (2018) Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 46:1362–1370. https://doi.org/10.1177/0363546518758016

    Article  PubMed  Google Scholar 

  2. Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 43:746–751. https://doi.org/10.1302/0301-620X.43B4.746

    Article  PubMed  Google Scholar 

  3. Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 47:984–990

    Article  PubMed  Google Scholar 

  4. Martin R, Birmingham TB, Willits K, Litchfield R, LeBel M-E, Giffin JR (2014) Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 42:1118–1126. https://doi.org/10.1177/0363546514525929

    Article  PubMed  Google Scholar 

  5. Jung W-H, Chun C-W, Lee J-H, Ha J-H, Kim J-H, Jeong J-H (2013) No difference in total blood loss, haemoglobin and haematocrit between continues and intermittent wound drainage after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2831–2836. https://doi.org/10.1007/s00167-012-2253-6

    Article  PubMed  Google Scholar 

  6. Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J (2015) The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop 39:653–658. https://doi.org/10.1007/s00264-014-2455-2

    Article  PubMed  Google Scholar 

  7. Zhou X-D, Li J, Xiong Y, Jiang L-F, Li W-J, Wu L-D (2013) Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37:2109–2118. https://doi.org/10.1007/s00264-013-2053-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Zhu G (2015) No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial. Arch Orthop Trauma Surg 135:709–713. https://doi.org/10.1007/s00402-015-2192-z

    Article  PubMed  Google Scholar 

  9. Liu J-M, Chen W-Z, Fu B-Q, Chen J-W, Liu Z-L, Huang S-H (2016) The use of closed suction drainage in lumbar spinal surgery: is it really necessary? World Neurosurg 90:109–115. https://doi.org/10.1016/j.wneu.2016.02.091

    Article  PubMed  Google Scholar 

  10. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, Kuisma RP, Ylinen JE (1997) Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 84:839–844. https://doi.org/10.1097/00000539-199704000-00026

    Article  PubMed  Google Scholar 

  11. Suh DW, Kyung BS, Han S-B, Cheong K, Lee WH (2018) Efficacy of tranexamic acid for hemostasis in patients undergoing high tibial osteotomy. J Knee Surg 31:050–055. https://doi.org/10.1055/s-0037-1600091

    Article  Google Scholar 

  12. Palanisamy JV, Das S, Moon KH, Kim DH, Kim TK (2018) Intravenous tranexamic acid reduces postoperative blood loss after high tibial osteotomy. Clin Orthop Relat Res 476:2148–2154. https://doi.org/10.1097/CORR.0000000000000378

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim K-I, Kim HJ, Kim GB, Bae SH (2018) Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy. Orthop Traumatol Surg Res 104:1003–1007. https://doi.org/10.1016/j.otsr.2018.07.019

    Article  PubMed  Google Scholar 

  14. Wu J, Jin Y, Zhang J, Shao H, Yang D, Chen J (2014) Hemostatic techniques following multilevel posterior lumbar spine surgery: a randomized control trial. J Spinal Disord Tech 27:442–446. https://doi.org/10.1097/BSD.0000000000000063

    Article  PubMed  Google Scholar 

  15. Cho SK, Yi JS, Park MS, Hu G, Zebala LP, Pahys JM, Kang MM, Lee DH, Riew KD (2012) Hemostatic techniques reduce hospital stay following multilevel posterior cervical spine surgery. J Bone Jt Surg Am 94:1952–1958. https://doi.org/10.2106/jbjs.k.00632

    Article  Google Scholar 

  16. Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232. https://doi.org/10.5555/uri:pii:0039606062901666

    Article  PubMed  Google Scholar 

  17. Boissonneault AR, Schenker M, Staley C, Roorbach M, Erwood AA, Grabel ZJ, Moore T, Reisman W, Maceroli M (2019) Impact of closed suction drainage after surgical fixation of acetabular fractures. Arch Orthop Trauma Surg 139:907–912. https://doi.org/10.1007/s00402-019-03110-0

    Article  PubMed  Google Scholar 

  18. Si H-B, Yang T-M, Zeng Y, Shen B (2016) No clear benefit or drawback to the use of closed drainage after primary total knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 17:183–183. https://doi.org/10.1186/s12891-016-1039-2

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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 89:1480–1483

    PubMed  Google Scholar 

  20. McMillan TE, Gardner WT, Schmidt AH, Johnstone AJ (2019) Diagnosing acute compartment syndrome-where have we got to? Int Orthop 43:2429–2435. https://doi.org/10.1007/s00264-019-04386-y

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kęska R, Paradowski TP, Witoński D (2014) Outcome in primary cemented total knee arthroplasty with or without drain: a prospective comparative study. Indian J Orthop 48:404–409. https://doi.org/10.4103/0019-5413.136285

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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 Arthroplast 12:317–321. https://doi.org/10.1016/S0883-5403(97)90029-2

    Article  Google Scholar 

Download references

Acknowledgements

We thank Professor Yuchen Fan from Qilu Hospital of Shandong University for his help in statistics.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, China

    Songlin Li, Qunshan Lu, Meng Zhang, Zhuang Miao, Desu Luo & Peilai Liu

  2. Department of Orthopedics, Laoling Hospital of traditional Chinese Medicine, Dezhou, Shandong, China

    Jianling Yang

  3. Shandong University Cheeloo College of Medicine, Jinan, Shandong, China

    Christiaan Watson

Authors
  1. Songlin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jianling Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christiaan Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qunshan Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Meng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhuang Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Desu Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peilai Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peilai Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This trial was approved by the ethics committee of the local hospital (KYLL-2017-001) and was registered at ClinicalTrials.gov, number NCT-03954860.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, S., Yang, J., Watson, C. et al. Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study. International Orthopaedics (SICOT) 44, 1037–1043 (2020). https://doi.org/10.1007/s00264-020-04530-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04530-z

Keywords

Search

Navigation