Does drain matter in primary total knee replacement surgeries?

Abstract

BackgroundDrains has traditionally been used in primary total knee replacement(TKR)surgeries, but its use still controversial. Recent trends in total knee replacement has inclined towards operating without the use of drains. Drains decreases tension over the incision ultimately decreasing pain, ecchymosis and need for change of dressings. However, tamponade effect does not occur at surgical site increasing bleeding which in turn increases requirement of post-operative blood transfusion and transfusion related complications. It also increases chances of retrograde infection. Therefore this study was undertaken to clarify and compare the role of drainage system in total knee replacement surgeries. Material and method62 randomly allocated patients undergoing unilateral or bilateral primary TKR surgeries has been studied in two groups of 31 patients each viz without drain and with drain with respect to percentage drop of haemoglobin, requirement of blood transfusion and wound complication as wound dehiscence, necrosis of wound margin, wound infection (superficial/deep) within one month of primary TKR surgeries. ResultThe difference of mean drop of hemoglobin, required post-op blood transfusion, mean unit of blood transfusion, mean hospital stay was statistically insignificant. In group without drain 3.2% had wound margin necrosis and superficial wound infection treated with oral antibiotics, rest all thirty patient did well; while in group with drain, none of the patient had wound margin necrosis. No significant association was seen between the percentage of the patients having wound dehiscence and wound margin necrosis, superficial or deep infections in the two groups. ConclusionThe use of drains confer no added benefits or harm in primary TKR surgeries and their use should be individualised depending upon Surgeons preferences, experiences and set ups.