Abstract
Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding. In a prospective, randomised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis. We compared blood loss, number of transfusions, postoperative complications and knee function and found significantly less postoperative blood loss through the drains (p < 0.001), and fewer blood transfusions (p = 0.09) were needed in the clamped group. We conclude that clamping drainage after total knee arthroplasty in severe osteoarthritis reduces blood loss through the drains and the need for blood transfusions.
Résumé
La prothèse totale du genou dans les gonarthroses sévères nécessite souvent une résection tissulaire importante, celle-ci étant souvent associée à un saignement important. Nous avons réalisé une étude prospective randomisée comparant le drainage conventionnel post-opératoire versus clampage du drain durant 4 heures chez 60 patients ayant bénéficié d’une prothèse totale du genou pour une gonarthrose importante. Nous avons comparé les pertes sanguines, le nombre de transfusion, les complications post-opératoires, la fonction du genou. Nous avons observé qu’il y avait beaucoup moins de pertes sanguines dans les drains (p < 0.001) et beaucoup moins de transfusions (p = 0.009) dans le groupe des patients dont le drain avait été clampé pendant 4 heures. Nous pouvons conclure que le clampage du drain après prothèse totale du genou dans les gonarthroses sévères permet de réduire les pertes sanguines et le nombre de transfusions.
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References
Bernard L, Pron B, Vuagnat A, Gleizes V, Signoret F, Denormandie P, Si-Ali A, Perrone C, Feron JM, Gaillard JL, Groupe d’Etude sur l’Ostéite (2002) The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients. Clin Infect Dis 34:46–49
Brecher ME, Monk T, Goodnough LT (1997) A standardized method for calculating blood loss. Transfusion 37:1070–1074
Burnett S, Hart DJ, Cooper C et al (1994) A radiographic atlas of osteoarthritis. Springer, London
Clark CR, Spratt KF, Blondin M, Craig S, Fink L (2006) Perioperative autotransfusion in total hip and knee arthroplasty. J Arthroplasty 21:23–35
Esler CNA, 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 85:215–217
Fiebig E (1998) Safety of the blood supply. Clin Orthop Relat Res 357:6–18
Han SH, Bahk JH, Kim JH, Lim YJ, Park CD, Do SH, Park YS (2006) The effect of esmolol-induced controlled hypotension in combination with acute normovolemic hemodilution on cerebral oxygenation. Acta Anaesthesiol Scand 50:863–868
Holt BT, Parks NL, Engh GA et al (1997) Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty. Orthopedics 20(12):1121–1124
Kiely N, Hockings M, Gambhir A (2001) Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial. Knee 8:325–327
Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop 347:188–193
Müller U, Exadaktylos A, Roeder C, Pisan M, Eggli S, Jüni P (2004) Effect of a flow chart on use of blood transfusions in primary total hip and knee replacement: prospective before and after study. BMJ 328:934–938
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:1146–1152
Prasad N, Padmanabhan V, Mullaji A (2005) Comparison between two methods of drain clamping after total knee arthroplasty. Arch Orthop Trauma Surg 125:381–384
Shen PC, Jou IM, Lin YT, Lai KA, Yang CY, Chern TC (2005) Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty. J Arthroplasty 20:909–913
Tsumara N, Yoshiya S, Chin T, Shiba R, Kohso K, Doita M (2006) A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty. J Bone Joint Surg Br 88:49–53
Walmsley PJ, Kelly MB, Hill RMF, Brenkel I (2005) A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br 87:1397–1401
Wittmann FW, Ring PA (1984) Blood loss associated with Ring uncemented total knee replacement: comparison between continuous and intermittent suction drainage. J R Soc Med 77:556–558
Yamada K, Imaizumi T, Uemura M, Takada N, Kim Y (2001) Comparison between 1-hour and 24-hour drain clamping using diluted epinephrine solution after total knee arthroplasty. J Arthroplasty 16:458–462
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
Acknowledgements
This study was supported by: Pfizer EU ARTICULUM Fellowship, Lunds sjukvårdsdistrikt/Region Skåne, the Swedish Research Council (Project 73X-09509), the Swedish National Board of Health and Welfare and the Medical Faculty, University of Lund, Sweden.
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Stucinskas, J., Tarasevicius, S., Cebatorius, A. et al. Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial. International Orthopaedics (SICOT) 33, 1275–1278 (2009). https://doi.org/10.1007/s00264-008-0662-4
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DOI: https://doi.org/10.1007/s00264-008-0662-4