Role of drain in early clinical outcomes following primary total knee arthroplasty

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To compare and study the short-term clinical outcome in patients with or without a drain usage in primary total knee arthroplasty (TKA). A prospective cohort study in a consecutive series of 61 women and 39 men (mean age, 66 years) with primary osteoarthritis underwent unilateral TKA. In the first 50 patients a low suction pressure drain was used for six hours, and in the next 50 patients no drain was used following TKA. The 2 groups were comparable in terms of preoperative characteristics, age group, the proportion of patients with pharmacological prophylaxis for deep vein thrombosis, usage of anti fibrinolytics before surgery, the tourniquet time, mode of anaesthesia, operative approach and steps and type of implant used. The mean drain output in the drain group was 92 ml. The time to achieve straight-leg raising was earlier in the drain group (2.1 vs. 3.2 days, p < 0.005), and time to achieve knee flexion to 90° is earlier in patients with drain group (6.2 vs. 7.7 days, p < 0.005). In addition, patients of drain group had lesser postoperative wound soakage, need for dressing change and analgesics. The fall in haemoglobin rate was slightly more in drain group however there was no significant difference in the rate of blood transfusions in both groups and no significant difference in infection rate. The use of a short duration (six hours), low suction pressure drain following total knee replacement enabled earlier return of quadriceps power, and range of motion, without increasing infection and blood transfusion rate. It also resulted in less pain and reduction in analgesic requirement in early postoperative period.