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Closed suction drainage is not beneficial in hybrid total hip arthroplasty with intra-articular administration of tranexamic acid: a propensity score-matched cohort study

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Abstract

Purpose

This retrospective study aimed to evaluate the benefits of closed suction drainage (CSD) in hybrid total hip arthroplasty (THA) with intra-articular administration of tranexamic acid (TXA).

Methods

We included 369 hips that underwent primary hybrid THA between November 2015 and September 2020. We compared peri-operative blood test results, blood loss, and post-operative complications including transfusion, wound complications, and venous thromboembolism (VTE) with or without CSD. Propensity score matching was performed to balance baseline patient demographics.

Results

Transfusion, wound complications, and VTE were observed in 1.9% (seven), 2.4% (nine), and 2.2% (eight) of hips, respectively. There were no significant differences in transfusion, blood loss, wound complications, and deep venous thrombosis in both overall patients and propensity score-matched patients with or without CSD. The calculated total blood loss was approximately 600 ml and showed no significant difference between the two groups in the matched cohort (p = 0.59).

Conclusion

CSD does not provide any benefits and is not needed in primary hybrid THA with intra-articular administration of TXA.

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Code availability

Not applicable.

Availability of data

The datasets analysed in this study are available from the corresponding author on reasonable request.

References

  1. Levy M (1984) Intraperitoneal drainage. Am J Surg 147:309–314. https://doi.org/10.1016/0002-9610(84)90156-9

    Article  CAS  PubMed  Google Scholar 

  2. Nanni M, Perna F, Calamelli C, Donati D, Ferrara O, Parlato A et al (2013) Wound drainages in total hip arthroplasty: to use or not to use? Review of the literature on current practice. Musculoskelet Surg 97:101–107. https://doi.org/10.1007/s12306-013-0270-3

    Article  CAS  PubMed  Google Scholar 

  3. Chen ZY, Gao Y, Chen W, Li X, Zhang YZ (2014) Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol 24:939–946. https://doi.org/10.1007/s00590-013-1284-0

    Article  PubMed  Google Scholar 

  4. Suarez JC, McNamara CA, Barksdale LC, Calvo C, Szubski CR, Patel PD (2016) Closed suction drainage has no benefits in anterior hip arthroplasty: a prospective, randomized trial. J Arthroplasty 31:1954–1958. https://doi.org/10.1016/j.arth.2016.02.048

    Article  PubMed  Google Scholar 

  5. 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 73:625–629. https://doi.org/10.1080/000164702321039570

    Article  PubMed  Google Scholar 

  6. Parker MJ, Livingstone V, Clifton R, McKee A (2007) Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev (3):CD001825. https://doi.org/10.1002/14651858.CD001825.pub2

  7. 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 87:1397–1401. https://doi.org/10.1302/0301-620X.87B10.16221

    Article  CAS  PubMed  Google Scholar 

  8. Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K et al (2018) The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. J Arthroplasty 33:3083-3089.e4. https://doi.org/10.1016/j.arth.2018.06.023

    Article  PubMed  Google Scholar 

  9. Wei W, Wei B (2014) Comparison of topical and intravenous tranexamic acid on blood loss and transfusion rates in total hip arthroplasty. J Arthroplasty 29:2113–2116. https://doi.org/10.1016/j.arth.2014.07.019

    Article  PubMed  Google Scholar 

  10. Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Bini SA, Clarke HD et al (2018) Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty 33:3065–3069. https://doi.org/10.1016/j.arth.2018.08.002

    Article  PubMed  Google Scholar 

  11. Bartosz P, Marczyński W, Para M, Kogut M, Białecki J (2021) Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study. BMC Musculoskelet Disord 22:688. https://doi.org/10.1186/s12891-021-04583-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  CAS  PubMed  Google Scholar 

  13. Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280. https://doi.org/10.1097/00000542-198303000-00016

    Article  CAS  PubMed  Google Scholar 

  14. Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232

    PubMed  Google Scholar 

  15. 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 12:317–321. https://doi.org/10.1016/s0883-5403(97)90029-2

    Article  CAS  PubMed  Google Scholar 

  16. Xu H, Xie J, Lei Y, Huang Q, Huang Z, Pei F (2019) Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study. J Orthop Surg Res 14:163. https://doi.org/10.1186/s13018-019-1211-0

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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 37:2109–2118. https://doi.org/10.1007/s00264-013-2053-8

    Article  PubMed  PubMed Central  Google Scholar 

  18. Almeida RP, Mokete L, Sikhauli N, Sekeitto AR, Pietrzak J (2021) The draining surgical wound post total hip and knee arthroplasty: what are my options? A narrative review. EFORT Open Rev 6:872–880. https://doi.org/10.1302/2058-5241.6.200054

    Article  PubMed  PubMed Central  Google Scholar 

  19. Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86:1146–1152. https://doi.org/10.2106/00004623-200406000-00005

    Article  PubMed  Google Scholar 

  20. Kelly EG, Cashman JP, Imran FH, Conroy R, O’Byrne J (2014) Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty. Surg Technol Int 24:295–301

    PubMed  Google Scholar 

  21. Cao JG, Wang L, Liu J (2015) The use of clamped drainage to reduce blood loss in total hip arthroplasty. J Orthop Surg Res 10:130. https://doi.org/10.1186/s13018-015-0259-8

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. J Arthroplasty 13:156–161. https://doi.org/10.1016/s0883-5403(98)90093-6

    Article  CAS  PubMed  Google Scholar 

  23. 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 127:919–923. https://doi.org/10.1007/s00402-006-0260-0

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Yaichiro Okuzu, Koji Goto, Yutaka Kuroda, Toshiyuki Kawai & Shuichi Matsuda

Authors
  1. Yaichiro Okuzu
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  2. Koji Goto
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  3. Yutaka Kuroda
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  4. Toshiyuki Kawai
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  5. Shuichi Matsuda
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Contributions

YO collected and interpreted the patient data. YO was the major contributor in the writing of the manuscript. KG, YK, TK, and SM were involved in report design, critically revised the report, and commented on drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yaichiro Okuzu.

Ethics declarations

Ethics approval

This retrospective study was approved by our local institutional review board.

Consent to participate

Written informed consent was obtained from all patients in this study to participate retrospective studies in our institution.

Consent for publication

Written informed consent was obtained from all patients in this study for publication.

Conflict of interest

The authors declare no competing interests.

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Cite this article

Okuzu, Y., Goto, K., Kuroda, Y. et al. Closed suction drainage is not beneficial in hybrid total hip arthroplasty with intra-articular administration of tranexamic acid: a propensity score-matched cohort study. International Orthopaedics (SICOT) 46, 1281–1287 (2022). https://doi.org/10.1007/s00264-022-05366-5

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  • DOI: https://doi.org/10.1007/s00264-022-05366-5

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