Blood transfusion in total hip endoprosthesis operations in relation to Redon drainage and pressure bandages. An innovation in surgical method

Abstract

There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim of the study was to find the best version. In a prospective randomized study including 158 patients with coxarthrosis we implanted cementless Alloclassic hip-endoprostheses and registered consumption of blood, blood loss, hemoglobin level, subcutaneuos hematoma, swelling of the proximal thigh, bleeding and exsudation of the wound in four groups supplied with three, two (subcutaneously and subfascial) and one (subcutaneously or subfascial) drainage with compression bandage and one group with two redons (subcutaneously and subfascial) without compression bandage. For prophylaxis of deep vein thrombosis we used low dose heparin. We could demonstrate, that the application of two redons one subcutaneously and one subfascial gave the best result. Compared to the conventional procedure with three redons we achieved a reduction of 47% of blood units, a significant reduction of exsudation and bleeding out of the wound, subcutaneous hematomas and a reduced swelling of the proximal leg in addition to better clinical conditions of the patients. The reason is a more accelerated stop of the bleeding out of the spongy bone. The application of one drain subcutaneously or subfascial showed no further reduction of blood loss, but an increase of wound exsudation and bleeding out the wound and an increase of subcutaneous hematomas. Sufficient external compression of the area of operation by a compression bandage is very important. Disadvantages as a result of changing the way of drainage have not been detected. The use of two Redons one subcutaneously and one subfascial showed an obvious benefit without any clinical disadvantage compared to 3 redons or no drainage.