Abstract
PurposeIncreased blood loss remains a major drawback of simultaneous bilateral total hip arthroplasty (SBTHA). We examined the effects of disusing closed suction drainage (CSD) on postoperative blood loss and transfusion requirement in cementless SBTHA.MethodsA retrospective cohort study was conducted with a consecutive series of cementless SBTHAs performed by a single surgeon between January 2014 and March 2017. The surgeon routinely used CSD until May 2015 and refrained from CSD in all primary THAs thereafter. This study included SBTHAs with intravenous administration of tranexamic acid (TXA). Postoperative hemoglobin drop, blood loss, transfusion rate, pain scores, complication rates, and implant survivorships were compared between the groups of SBTHA with and without CSD. The minimum follow-up duration was 1 year.ResultsAmong the 110 patients (220 hips), 46 (92 hips) and 64 (128 hips) underwent SBTHA with and without CSD, respectively. Maximum hemoglobin drop (mean, 4.8 vs. 3.9 g/dL; P = 0.001), calculated blood loss (mean, 1530 vs. 1190 mL; P<0.001), transfusion rate (45.7% vs. 21.9%; P = 0.008), and length of hospital stay (mean, 6.6 vs. 5.8 days; P = 0.004) were significantly lower in patients without CSD. There were no significant differences in postoperative pain scales and wound complication rates. The mean Harris Hip scores at final follow-up (92.5 vs. 92.1; P = 0.775) and implant survivorships with an end-point of any revision at 4 years (98.9% vs. 98.4%; log-rank, P = 0.766) were similar between groups.ConclusionsDisusing CSD significantly reduced postoperative blood loss and transfusion requirement without increasing postoperative pain and surgical wound complications in cementless SBTHA with concurrent administration of intravenous TXA.
Highlights
Many individuals requiring total hip arthroplasty (THA) have a predisposing condition, commonly affecting both hips
Some surgeons disagree with the routine use of Closed suction drainage (CSD) in THA, as it may interfere with the natural tamponade effect and lead to increased bleeding without providing obvious benefits [20,21,22]
We reviewed consecutive series of 110 cementless simultaneous bilateral total hip arthroplasty (SBTHA) to evaluate the effect of disusing CSD on perioperative blood loss and transfusion
Summary
Many individuals requiring total hip arthroplasty (THA) have a predisposing condition, commonly affecting both hips (e.g., developmental dysplasia, osteonecrosis, rheumatoid arthritis, and ankylosing spondylitis). It has been reported that 16–85% of those undergoing unilateral THA with bilateral disease eventually required contralateral THA [1,2,3,4]. For these patients, simultaneous bilateral total hip arthroplasty (SBTHA) can be an attractive option; it offers several potential advantages over staged bilateral THA, including a single anesthesia, shorter total operation time and hospital stay, lower overall cost, reduced recovery and rehabilitation time, and earlier return to daily activities [5,6,7,8,9]. There are still controversies over the CSD use in THA, which largely depends on the surgeon’s preference
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