Drainage In Total Knee Arthroplasty Research Articles

Subcutaneous barbed suture, as an adjunct to staples, reduces post-operative wound drainage in total knee arthroplasty

BackgroundProlonged wound drainage (>72 h), has been associated with increased risk of surgical site infection and prolonged hospital admission. This study reviews the outcome in three different wound closure methods, following total knee arthroplasty. We also analysed the cost effectiveness of these methods. MethodsA total of 69 patients undergoing total knee arthroplasty: 22 with stapled skin closure; 21 with tissue adhesive and stapled skin closure and 26 with subcutaneous barbed suture instead of a non barbed suture with stapled skin closure, were studied to review the number of dressing changes, prolonged wound drainage (>72 h), length of hospital stay and delayed discharge (>5 days). Statistical analysis was conducted using Minitab Statistical Software® and statistical significance was set at p < 0.05. ResultsThe median hospital stay for the staples only group was 4 days (inter-quartile range [IQR] 3–5), for the adhesive group was 4 days ([IQR] 3–6) and for the barbed suture group was 3 days ([IQR] 3–4) (p = 0.009). The rates of prolonged wound drainage for the staples only group was 8 (36.4%), for the adhesive group was 4 (19.0%) and for barbed suture group was 0 (0%) (p = 0.004). ConclusionThe use of subcutaneous barbed sutures was associated with reduced number of wound dressing changes, reduced risk of prolonged wound drainage and shorter hospital stay, as well as conferring a saving of at least £236.60 per patient, compared to the other two skin closure methods.

Comparison of blood loss and clinical outcomes associated with closed suction drainage in total knee arthroplasty

Comparison of blood loss and clinical outcomes associated with closed suction drainage in total knee arthroplasty

Efficacy of postoperative drainage in total knee arthroplasty: Review of the literature.

Postoperative drainage after total knee arthroplasty (TKA) is an established routine procedure for orthopedic surgeries, and is considered a useful practice in postoperative, but the use of drainage is controversial. Our study aims to clarify this aspect of knee prosthetic surgery. A systematic review of the literature was performed in the electronic databases to investigate the risks and the benefits of wound drainage in total knee arthroplasty: 30 articles were included in our review for eligibility. After the analysis of the literature performed, we found no significant advantages related with the use of wound drain following total knee replacement (TKR) in terms of pain, transfusion rate, blood loss, swelling, postoperative range of motion, wound complications, deep infection and hospital stay, while no drainage means a significant cost saving compared to drainage use. Thus, the use of drainage after TKA cannot be justified on the basis of the results of this study.

Postoperative Drainage in Total Knee Arthroplasty in the Presence of Tranexamic Acid

Postoperative Drainage in Total Knee Arthroplasty in the Presence of Tranexamic Acid

The use of postoperative suction drainage in total knee arthroplasty: a systematic review.

The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, length of hospital stay and haemoglobin levels following TKA. Six randomised controlled trials were included. There is no significant difference between the individuals who receive a drain and those who do not across any of the measures examined (p < 0.05). This analysis demonstrates no statistical difference in ROM [mean difference 0.03° (95 %CI -1.51 to 1.45, p = 0.64, I(2) = 0 %)]. , nor in knee circumference [mean difference 1.63 cm (95 % CI -1.07 - 4.34 cm, p = 0.34), [I(2) = 0.12]. The finding raises the possibility that drains are not required to assist in recovery following TKA.

Late Tourniquet Release and Drain Clamping Reduces Postoperative Blood Loss in Total Knee Arthroplasty

Many studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty. The aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA. Ninety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function. We found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function. We conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery.

Non-drainage Is Better Than 4-Hour Clamping Drainage in Total Knee Arthroplasty

The role of wound drainage in total knee arthroplasty (TKA) is controversial. The use of drainage was believed to be effective in decreasing hematoma formation, but it inevitably increases bleeding because the tamponade effect of a closed and undrained wound is eliminated. Clamping the drain tube in the first 4 hours after TKA can temporarily recreate a tamponade effect for bleeding control. Previous studies compared the clamping drainage with the conventional drainage method but not with non-drainage. Some current studies have shown that drainage in TKA is not necessary. Thus, we conducted a study to compare the outcomes between the patients with temporarily clamping drainage and without drainage.One hundred consecutive patients undergoing primary TKA were included. Change of hemoglobin, blood transfusion, use of narcotics, postoperative wound dressing, length of hospital stay, and range of motion were recorded. The drain-clamping group demonstrated more postoperative hemoglobin loss and a longer hospital stay, and gained no benefit compared with the non-drain group. Therefore, we concluded that despite clamping for 4 hours after TKA, the drain was still of no use. We would not recommend using a draining system routinely after TKA.

The Use of Postoperative Suction Drainage in Total Knee Arthroplasty

A retrospective review of 299 total knee arthroplasties performed between 1973 and 1983 revealed 170 knees in which postoperative suction drainage was used and 129 knees in which drains were not used. Comparison between these two groups revealed no statistically significant difference in wound problems, postoperative temperatures, or resulting range of motion. However, blood transfusions were given more than twice as often to the patients whose knees were drained (39% compared to 16%, p less than .01). The drained group also had a greater decrease in hemoglobin than the nondrained group (3.1 gm compared to 2.6 gm, p less than .01). In a review of these patients, no advantage was found for the use of postoperative suction drainage in the uncomplicated total knee arthroplasty.