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Published in: International Orthopaedics 3/2016

01-03-2016 | Original Paper

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

Authors: Simcha G. Fichman, Tatu J. Mäkinen, Benjamin Lozano, Wael A. Rahman, Oleg Safir, Allan E. Gross, David Backstein, Paul R. T. Kuzyk

Published in: International Orthopaedics | Issue 3/2016

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Abstract

Purpose

Several studies have failed to show significant benefits of closed suction drainage (CSD) in routine primary total hip arthroplasty (THA). However, blood loss, haematoma formation and wound complications are generally much greater in revision THA as compared to primary THA. The purpose of this study was to determine if CSD is beneficial for revision THA patients.

Methods

We conducted a prospective, randomized, controlled trial at our institution between July 2013 and July 2014. Eighty-eight patients undergoing revision THA were enrolled and randomly assigned to receive a CSD (n = 44) or to not receive a CSD (n = 44). All first-stage revision surgeries for infection were excluded. Primary outcomes were haemoglobin loss and number of patients transfused. Secondary outcomes included functional outcome evaluated with Harris hip score (HHS), pain evaluated with visual analogue scale (VAS), and length of hospital stay.

Results

There were significantly more patients in the CSD group that required blood transfusions (20/44 as compared to 11/44, p = 0.04). Patients in the no CSD group were discharged earlier than patients in the CSD group (4.3 days as compared to 5.4 days, p = 0.002). No statistical significant difference was found in the HHS or pain VAS between the groups.

Conclusions

This study did not demonstrate any benefit with the use of CSD for revision THA with regard to wound related complications, infection or early functional outcome. Post-operative blood loss, transfusion rate, and length of hospital stay may be higher with CSD.
Literature
1.
go back to reference Niskanen RO, Korkala OL, Haapala J, Kuokkanen HO, Kaukonen JP, Salo SA (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 15:567–569CrossRefPubMed Niskanen RO, Korkala OL, Haapala J, Kuokkanen HO, Kaukonen JP, Salo SA (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 15:567–569CrossRefPubMed
2.
go back to reference Widman J, Jacobsson H, Larsson SA, Isacson J (2002) No effect of drains on the postoperative hematoma volume in hip replacement surgery: a randomized study using scintigraphy. Acta Orthop Scand 73:625–629PubMed Widman J, Jacobsson H, Larsson SA, Isacson J (2002) No effect of drains on the postoperative hematoma volume in hip replacement surgery: a randomized study using scintigraphy. Acta Orthop Scand 73:625–629PubMed
3.
go back to reference Gonzalez Della Valle A, Slullitel G, Vestri R, Comba F, Buttaro M, Piccaluga F (2004) No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations. Acta Orthop Scand 75:30–33CrossRefPubMed Gonzalez Della Valle A, Slullitel G, Vestri R, Comba F, Buttaro M, Piccaluga F (2004) No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations. Acta Orthop Scand 75:30–33CrossRefPubMed
4.
go back to reference Dora C, von Campe A, Mengiardi B, Koch P, Vienne P (2007) Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations. Arch Orthop Trauma Surg 127:919–923CrossRefPubMed Dora C, von Campe A, Mengiardi B, Koch P, Vienne P (2007) Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations. Arch Orthop Trauma Surg 127:919–923CrossRefPubMed
5.
go back to reference Walmsley PJ, Kelly MB, Hill RM, Brenkel I (2005) A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg (Br) 87:1397–1401CrossRef Walmsley PJ, Kelly MB, Hill RM, Brenkel I (2005) A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg (Br) 87:1397–1401CrossRef
6.
go back to reference Cheung G, Carmont MR, Bing AJ, Kuiper JH, Alcock RJ, Graham NM (2010) No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients. Acta Orthop Belg 76:619–627PubMed Cheung G, Carmont MR, Bing AJ, Kuiper JH, Alcock RJ, Graham NM (2010) No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients. Acta Orthop Belg 76:619–627PubMed
7.
go back to reference Kleinert K, Werner C, Mamisch-Saupe N, Kalberer F, Dora C (2012) Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach. Arch Orthop Trauma Surg 132:131–136CrossRefPubMed Kleinert K, Werner C, Mamisch-Saupe N, Kalberer F, Dora C (2012) Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach. Arch Orthop Trauma Surg 132:131–136CrossRefPubMed
8.
go back to reference von Roth P, Perka C, Dirschedl K, Mayr HO, Ensthaler L, Preininger B, Hube R (2012) Use of Redon drains in primary total hip arthroplasty has no clinically relevant benefits. Orthopedics 35:e1592–e1595CrossRef von Roth P, Perka C, Dirschedl K, Mayr HO, Ensthaler L, Preininger B, Hube R (2012) Use of Redon drains in primary total hip arthroplasty has no clinically relevant benefits. Orthopedics 35:e1592–e1595CrossRef
9.
go back to reference Overgaard S, Thomsen NO, Kulinski B, Mossing NB (1993) Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand 64:417–420CrossRefPubMed Overgaard S, Thomsen NO, Kulinski B, Mossing NB (1993) Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand 64:417–420CrossRefPubMed
10.
go back to reference Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD (2013) Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37:2109–2118PubMedCentralCrossRefPubMed Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD (2013) Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37:2109–2118PubMedCentralCrossRefPubMed
11.
go back to reference Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE (2011) The long modified extended sliding trochanteric osteotomy. Int Orthop 35:13–17PubMedCentralCrossRefPubMed Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE (2011) The long modified extended sliding trochanteric osteotomy. Int Orthop 35:13–17PubMedCentralCrossRefPubMed
12.
go back to reference Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA (2014) Systematic review on outcomes of acetabular revisions with highly-porous metals. Int Orthop 38:689–702PubMedCentralCrossRefPubMed Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA (2014) Systematic review on outcomes of acetabular revisions with highly-porous metals. Int Orthop 38:689–702PubMedCentralCrossRefPubMed
13.
go back to reference Hoberg M, Konrads C, Engelien J, Oschmann D, Holder M, Walcher M, Rudert M (2015) Outcome of a modular tapered uncemented titanium femoral stem in revision hip arthroplasty. Int Orthop. Feb 18. [Epub ahead of print] Hoberg M, Konrads C, Engelien J, Oschmann D, Holder M, Walcher M, Rudert M (2015) Outcome of a modular tapered uncemented titanium femoral stem in revision hip arthroplasty. Int Orthop. Feb 18. [Epub ahead of print]
14.
go back to reference Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Joint Surg Am 96:e158CrossRefPubMed Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Joint Surg Am 96:e158CrossRefPubMed
15.
go back to reference Matsuda K, Nakamura S, Wakimoto N, Kobayashi M, Matsushita T (2007) Drainage does not increase anemia after cementless total hip arthroplasty. Clin Orthop Relat Res 458:101–105PubMed Matsuda K, Nakamura S, Wakimoto N, Kobayashi M, Matsushita T (2007) Drainage does not increase anemia after cementless total hip arthroplasty. Clin Orthop Relat Res 458:101–105PubMed
16.
go back to reference Strahovnik A, Fokter SK, Kotnik M (2010) Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty. J Arthroplasty 25:244–248CrossRefPubMed Strahovnik A, Fokter SK, Kotnik M (2010) Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty. J Arthroplasty 25:244–248CrossRefPubMed
17.
go back to reference Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A:1146–1152PubMed Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A:1146–1152PubMed
18.
go back to reference Koyano G, Jinno T, Koga D, Hoshino C, Muneta T, Okawa A (2015) Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty. J Arthroplasty 30:74–78CrossRefPubMed Koyano G, Jinno T, Koga D, Hoshino C, Muneta T, Okawa A (2015) Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty. J Arthroplasty 30:74–78CrossRefPubMed
19.
go back to reference Ovadia D, Luger E, Bickels J, Menachem A, Dekel S (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12:317–321CrossRefPubMed Ovadia D, Luger E, Bickels J, Menachem A, Dekel S (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12:317–321CrossRefPubMed
20.
go back to reference Esler CN, Blakeway C, Fiddian NJ (2003) The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg (Br) 85:215–217CrossRef Esler CN, Blakeway C, Fiddian NJ (2003) The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg (Br) 85:215–217CrossRef
21.
go back to reference Bjerke-Kroll BT, Sculco PK, McLawhorn AS, Christ AB, Gladnick BP, Mayman DJ (2014) The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplasty 29:895–899CrossRefPubMed Bjerke-Kroll BT, Sculco PK, McLawhorn AS, Christ AB, Gladnick BP, Mayman DJ (2014) The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplasty 29:895–899CrossRefPubMed
22.
go back to reference Johansson T, Engquist M, Pettersson LG, Lisander B (2005) Blood loss after total hip replacement: a prospective randomized study between wound compression and drainage. J Arthroplasty 20:967–971CrossRefPubMed Johansson T, Engquist M, Pettersson LG, Lisander B (2005) Blood loss after total hip replacement: a prospective randomized study between wound compression and drainage. J Arthroplasty 20:967–971CrossRefPubMed
23.
go back to reference Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. J Arthroplasty 13:156–161CrossRefPubMed Kim YH, Cho SH, Kim RS (1998) Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. J Arthroplasty 13:156–161CrossRefPubMed
24.
go back to reference Beer KJ, Lombardi AV Jr, Mallory TH, Vaughn BK (1991) The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am 73:584–587PubMed Beer KJ, Lombardi AV Jr, Mallory TH, Vaughn BK (1991) The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am 73:584–587PubMed
25.
go back to reference Ritter MA, Keating EM, Faris PM (1994) Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 76:35–38PubMed Ritter MA, Keating EM, Faris PM (1994) Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 76:35–38PubMed
26.
go back to reference Moráis S, Ortega-Andreu M, Rodríguez-Merchán EC, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R, Gómez-Barrena E (2014) Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop 38:347–354PubMedCentralCrossRefPubMed Moráis S, Ortega-Andreu M, Rodríguez-Merchán EC, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R, Gómez-Barrena E (2014) Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop 38:347–354PubMedCentralCrossRefPubMed
27.
go back to reference Sukeik M, Alshryda S, Haddad FS, Mason JM (2011) Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg (Br) 93:39–46CrossRef Sukeik M, Alshryda S, Haddad FS, Mason JM (2011) Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg (Br) 93:39–46CrossRef
28.
go back to reference Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM (2014) A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 96-B:1005–1015CrossRefPubMed Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM (2014) A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 96-B:1005–1015CrossRefPubMed
29.
go back to reference Kazi HA, Fountain JR, Thomas TG, Carroll FA (2012) The effect of bolus administration of tranexamic acid in revision hip arthroplasty. Hip Int 22:615–620CrossRefPubMed Kazi HA, Fountain JR, Thomas TG, Carroll FA (2012) The effect of bolus administration of tranexamic acid in revision hip arthroplasty. Hip Int 22:615–620CrossRefPubMed
Metadata
Title
Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial
Authors
Simcha G. Fichman
Tatu J. Mäkinen
Benjamin Lozano
Wael A. Rahman
Oleg Safir
Allan E. Gross
David Backstein
Paul R. T. Kuzyk
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 3/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2960-y

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