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Subcutaneous versus intraarticular closed suction indwelling drainage after total knee arthroplasty

A randomised control trial

  • Original Article
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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: Total knee arthroplasty (TKA) is widely accepted treatment for moderate or severe osteoarthritis and rheumatoid arthritis. Significant blood loss can be seen during the early postoperative period where a blood transfusion may be necessary. Closed suction drainage is known to prevent the formation of hematomas in the operative field, decrease tension on incisions, diminish delayed wound healing and reduce the risk of infection. Subcutaneous indwelling closed suction drainage method has been known to be beneficial and an alternative to the intraarticular indwelling method. This prospective randomized study was to compare the visible, hidden, total blood loss and postoperative hemodynamic change of subcutaneous and intraarticular indwelling closed suction drainage method after TKA.

Materials and Methods: One hundred and sixty patients with primary osteoarthritis who underwent unilateral TKA were enrolled; group A with subcutaneous (n = 78) and group B with intraarticular (n = 79) indwelling closed suction drainage method. Total blood loss, visible blood loss, internal blood loss, postoperative day 1, 5th, 10th day hemoglobin, hematocrit levels were compared. Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.

Results: Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002). Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.

Conclusion: Subcutaneous indwelling closed suction drainage method is a reasonable option after TKA for reduction of postoperative bleeding and transfusion rate.

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References

  1. Gascón P, Zoumbos NC, Young NS. Immunologic abnormalities in patients receiving multiple blood transfusions. Ann Intern Med 1984;100:173–7.

    Article  Google Scholar 

  2. Newman JH, Bowers M, Murphy J. The clinical advantages of autologous transfusion. A randomized, controlled study after knee replacement. J Bone Joint Surg Br 1997;79:630–2.

    Article  CAS  Google Scholar 

  3. Kim GH, Park SW, Kim JH, In Y. The efficacy of unilateral use of a blood reinfusion device in one-stage bilateral total knee arthroplasty. Knee Surg Relat Res 2014;26:7–12.

    Article  Google Scholar 

  4. Sinha A, Sinha M, Burgert S. Reinfusion of drained blood as an alternative to homologous blood transfusion after total knee replacement. Int Orthop 2001;25:257–9.

    Article  CAS  Google Scholar 

  5. Juelsgaard P, Larsen UT, Sørensen JV, Madsen F, Søballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: Reduced blood loss and transfusion. Reg Anesth Pain Med 2001;26:105–10.

    CAS  PubMed  Google Scholar 

  6. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early postoperative blood loss after total knee arthroplasty: A prospective randomised controlled trial of 29 patients. Knee 2006;13:106–10.

    Article  Google Scholar 

  7. Yamada K, Imaizumi T, Uemura M, Takada N, Kim Y. Comparison between 1-hour and 24-hour drain clamping using diluted epinephrine solution after total knee arthroplasty. J Arthroplasty 2001;16:458–62.

    Article  CAS  Google Scholar 

  8. Bae KC, Cho CH, Lee KJ, Son ES, Lee SW, Lee SJ, et al. Efficacy of intraarticular injection of thrombin-based hemostatic agent in the control of bleeding after primary total knee arthroplasty. Knee Surg Relat Res 2014;26:236–40.

    Article  Google Scholar 

  9. Tsumara N, Yoshiya S, Chin T, Shiba R, Kohso K, Doita M. A prospective comparison of clamping the drain or postoperative salvage of blood in reducing blood loss after total knee arthroplasty. J Bone Joint Surg Br 2006;88:49–53.

    Article  CAS  Google Scholar 

  10. Stucinskas J, Tarasevicius S, Cebatorius A, Robertsson O, Smailys A, Wingstrand H. Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: A prospective, randomised trial. Int Orthop 2009;33:1275–8.

    Article  Google Scholar 

  11. Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res 1998;347:188–93.

    Article  Google Scholar 

  12. Esler CN, Blakeway C, Fiddian NJ. The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 2003;85:215–7.

    Article  CAS  Google Scholar 

  13. Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH. No difference in total blood loss, haemoglobin and haematocrit between continues and intermittent wound drainage after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013;21:2831–6.

    Article  Google Scholar 

  14. Tai TW, Yang CY, Jou IM, Lai KA, Chen CH. Temporary drainage clamping after total knee arthroplasty: A meta-analysis of randomized controlled trials. J Arthroplasty 2010;25:1240–5.

    Article  Google Scholar 

  15. Seo ES, Yoon SW, Koh IJ, Chang CB, Kim TK. Subcutaneous versus intraarticular indwelling closed suction drainage after TKA: A randomized controlled trial. Clin Orthop Relat Res 2010;468:2168–76.

    Article  Google Scholar 

  16. Gross JB. Estimating allowable blood loss: Corrected for dilution. Anesthesiology 1983;58:277–80.

    Article  CAS  Google Scholar 

  17. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–4.

    Google Scholar 

  18. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15:1833–40.

    CAS  Google Scholar 

  19. Reilly TJ, Gradisar IA Jr, Pakan W, Reilly M. The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop Relat Res 1986;208:238–42.

    Google Scholar 

  20. Kumar S, Penematsa S, Parekh S. Are drains required following a routine primary total joint arthroplasty? Int Orthop 2007;31:593–6.

    Article  Google Scholar 

  21. Zhang QD, Guo WS, Zhang Q, Liu ZH, Cheng LM, Li ZR. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: A meta-analysis. J Arthroplasty 2011;26:1265–72.

    Article  Google Scholar 

  22. Kiely N, Hockings M, Gambhir A. Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. Knee 2001;8:325–7.

    Article  CAS  Google Scholar 

  23. Roy N, Smith M, Anwar M, Elsworth C. Delayed release of drain in total knee replacement reduces blood loss. A prospective randomised study. Acta Orthop Belg 2006;72:34–8.

    PubMed  Google Scholar 

  24. Prasad N, Padmanabhan V, Mullaji A. Comparison between two methods of drain clamping after total knee arthroplasty. Arch Orthop Trauma Surg 2005;125:381–4.

    Article  Google Scholar 

  25. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br 2004;86:561–5.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Korea

    Jae-Hyuk Yang, Jung-Ro Yoon, Anshul Dahuja & Seungyeop Song

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  1. Jae-Hyuk Yang
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  2. Jung-Ro Yoon
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  3. Anshul Dahuja
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  4. Seungyeop Song
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Correspondence to Jae-Hyuk Yang.

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Yang, JH., Yoon, JR., Dahuja, A. et al. Subcutaneous versus intraarticular closed suction indwelling drainage after total knee arthroplasty. IJOO 50, 59–64 (2016). https://doi.org/10.4103/0019-5413.173515

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  • DOI: https://doi.org/10.4103/0019-5413.173515

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