scholarly journals The usage of drainage after primary total hip or knee arthroplasty: best evidence selection and risk of bias considerations

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Huibin Long ◽  
Zhichang Li ◽  
Dan Xing ◽  
Yan Ke ◽  
Jianhao Lin
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Risk Of Bias ◽  
Low Risk ◽  
Suction Drainage ◽  
Decision Algorithm ◽  
Closed Suction ◽  
Closed Suction Drainage ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

Abstract Background Numerous systematic reviews investigating the benefit of the usage of drainage after primary total hip or knee arthroplasty have been published with divergent conclusions. We aim to determine the best available evidence and consider risk of bias of these articles and to provide recommendations. Methods A systematic search of systematic reviews published through to May 2020 was performed in MEDLINE, EMBASE and Cochrane library. Methodological quality, risk of bias and best evidence choice of included articles were evaluated by AMSTAR instrument, ROBIS tool and Jadad decision algorithm, respectively. We selected systematic reviews with high methodological quality and low risk of bias ultimately as best evidence. Results Twelve meta-analyses were included lastly. According to the ROBIS tool, seven of the included systematic reviews were with low risk of bias and five with high risk of bias. The Jadad decision algorithm suggested that two reviews conducted by Zan et al. for hip and Si et al. et al. for knee were selected as the best evidence, with highest AMSTAR score and low risk of bias. Conclusions Ten systematic reviews were included as low-quality with only two high-quality studies. Based on the current available evidence, we have insufficient confidence to draw conclusion that whether to use closed suction drainage for both total knee and hip arthroplasty. To verify the necessity and benefit of using closed suction drainage after primary total knee and hip arthroplasty, and develop exact recommendations, further studies are still required.

Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial

2018 ◽  
Vol 31 (08) ◽  
pp. 804-810 ◽  
Author(s):  
Felix Erne ◽  
Stefanie Wetzel ◽  
Nikolaus Wülker ◽  
Marco Gesicki ◽  
Ulf Hofmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Trial ◽  
Knee Arthroplasty ◽  
Prospective Randomized Trial ◽  
Postoperative Blood Loss ◽  
Suction Drainage ◽  
Closed Suction ◽  
Closed Suction Drainage ◽  
Total Knee

AbstractThe discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (p = 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (p = 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.

Comparison Between Closed Suction Drainage and Nondrainage in Total Knee Arthroplasty

2011 ◽  
Vol 26 (8) ◽  
pp. 1265-1272 ◽  
Author(s):  
Qi-dong Zhang ◽  
Wan-shou Guo ◽  
Qian Zhang ◽  
Zhao-hui Liu ◽  
Li-ming Cheng ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Suction Drainage ◽  
Closed Suction ◽  
Closed Suction Drainage ◽  
Total Knee

Risk Factors for Surgical-Site Infection Following Primary Total Knee Arthroplasty

2004 ◽  
Vol 25 (6) ◽  
pp. 477-480 ◽  
Author(s):  
Brian Minnema ◽  
Mary Vearncombe ◽  
Anne Augustin ◽  
Jeffrey Gollish ◽  
Andrew E. Simor
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Knee Arthroplasty ◽  
Site Infection ◽  
Suction Drainage ◽  
Closed Suction ◽  
Closed Suction Drainage ◽  
Total Knee

AbstractObjective:To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).Design:A case-control study.Setting:A 1,100-bed, university-affiliated, tertiary-care teaching hospital.Methods:Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.Results:Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.Conclusions:The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.

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