The role of suction drainage in the management of peri-operative bleeding in Total and Unicompartmental knee arthroplasty: a retrospective comparative study

Laura Mangiavini,Elisa Giacomina Pandini,Nicola Manta,Andrea Colombo,Roberto D’Anchise,Cristiana Balbino,Marco Viganò,Pierluigi Pironti

doi:10.1186/s12891-021-04868-4

Laura Mangiavini, Elisa Giacomina Pandini + Show 6 more

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https://doi.org/10.1186/s12891-021-04868-4

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Abstract

BackgroundSuction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing. However, its efficacy remains controversial; thus, the purpose of this study is to evaluate drainage efficiency in the management of postoperative bleeding in TKA and UKA.MethodsThe cohort comprised 134 clinical records of patients affected by knee osteoarthritis (OA) who underwent either TKA or UKA. All the patients were subdivided into 2 groups: the first one with drainage and the second one without drainage (respectively 61 and 73 patients). For each group, hemoglobin levels in the preoperative, first, second and third postoperative day were collected. Postoperative complications such as swelling, bleeding from the surgical wound or the need for blood transfusion, were also recorded.ResultsOur results did not show any significant difference of hemoglobin levels in the first (p = 0.715), second (p = 0.203) and third post-operative day (p = 0.467) between the two groups. Moreover, no significant correlation between knee swelling or transfusion rate and the drainage was observed (p = 0.703 and p = 0.662 respectively). Besides, a significant correlation was found between bleeding from the surgical wound and the absence of drainage (p = 0.006).ConclusionsThe study demonstrates how the routine use of suction drainage does not provide substantial benefits in the postoperative blood loss management after TKA or UKA.Trial registrationClinicalTrials.gov NCT04508101, 09/08/2020, Retrospectively registeredLevel of evidenceIII

Highlights

Suction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing
Even if it is a common belief that intra-articular suction drainage may reduce local hematoma, leading to swelling decrease, surgical wound healing improvement and reduction of postoperative infection rate [3, 4], drain use is likely to be associated with an increased risk of blood transfusion due to the lack of tamponade effect [1]
Concerning hemoglobin levels in the whole sample, we reported no statistically significant difference between the two groups at t (p = 0.266), t1 (p = 0.715), t2

Summary

Introduction

Suction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing. Total knee arthroplasty (TKA) is commonly considered one of the most effective orthopedic procedure in the treatment of end-stage knee OA and various rheumatic diseases such as rheumatoid arthritis, leading. The subsequent local bleeding may lead to anemia, functional limitation, nerve palsy and joint swelling resulting in healing impairment [1, 6]. Even if it is a common belief that intra-articular suction drainage may reduce local hematoma, leading to swelling decrease, surgical wound healing improvement and reduction of postoperative infection rate [3, 4], drain use is likely to be associated with an increased risk of blood transfusion due to the lack of tamponade effect [1].

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