J Knee Surg 2017; 30(06): 571-576
DOI: 10.1055/s-0036-1593618
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Removal of Drainage Tube after Fast-Track Primary Total Knee Arthroplasty

Shaoyun Zhang*
1   Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
,
Bin Xu*
1   Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
,
Qiang Huang
1   Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
,
Huan Yao
1   Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
,
Jinwei Xie
1   Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
,
Fuxing Pei
1   Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
› Institutsangaben
Weitere Informationen

Publikationsverlauf

07. April 2016

28. August 2016

Publikationsdatum:
24. Oktober 2016 (online)

Abstract

There is no consensus as to whether drainage tube should be used and how long it should remain in use after primary total knee arthroplasty (TKA). As fast-track (FT) program has been implemented in TKA, whether drainage tube could be removed early, and the ideal timing for removal after FT primary TKA has been a new topic. The purpose of this prospective cohort study was to evaluate the safety and feasibility of early removal of drainage tube when FT program was implemented in primary TKA. A total of 101 patients undergoing FT primary TKA were prospectively allocated into three groups. Patients in group A (31 patients) indwelled wound drainage tube for 6 hours after surgery while group B (34 patients) for 12 hours and group C (36 patients) for 18 hours. The knee circumference, resting and moving visual analogue score (VAS), hemoglobin (Hb), hematocrit, white blood count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), the volume of blood loss and drainage, and postoperative length of stay (LOS) among three groups were recorded and compared. There was no statistically significant difference in the volume of total and hidden blood loss among three groups (p > 0.05), but as the time of drainage prolonged, total volume of drainage and dominant blood loss increased gradually (p < 0.01). The knee circumference, the mean of resting and moving VAS, Hb, WBC, ESR, CRP, and IL-6 of three groups were similar preoperatively and on postoperative day 1 and 3 (p > 0.05), the decrease of Hb in the perioperative period and postoperative LOS as well. Early removal of wound drainage tube could drain the hematocele and reduce the risk of infection, and it doesn't increase the sense of pain, inflammatory reaction, limb swelling, and total blood loss. It's safe and feasible to remove the drainage tube within 6 to 12 hours after FT primary TKA.

* The authors Shaoyun Zhang and Bin Xu contributed equally to the article.


 
  • References

  • 1 Buckwalter JA, Lohmander S. Operative treatment of osteoarthrosis. Current practice and future development. J Bone Joint Surg Am 1994; 76 (09) 1405-1418
  • 2 Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res 1998; (347) 188-193
  • 3 Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183 (06) 630-641
  • 4 Husted H, Holm G. Fast track in total hip and knee arthroplasty--experiences from Hvidovre University Hospital, Denmark. Injury 2006; 37 (05) (Suppl. 05) S31-S35
  • 5 Esler CN, Blakeway C, Fiddian NJ. The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 2003; 85 (02) 215-217
  • 6 García-Erce JA, Manuel Solano V, Cuenca J, Ortega P. Preoperative hemoglobin as the only predictive factor of transfusional needs in knee arthroplasty [in Spanish]. Rev Esp Anestesiol Reanim 2002; 49 (05) 254-260
  • 7 Kourtzis N, Pafilas D, Kasimatis G. Blood saving protocol in elective total knee arthroplasty. Am J Surg 2004; 187 (02) 261-267
  • 8 Li C, Nijat A, Askar M. No clear advantage to use of wound drains after unilateral total knee arthroplasty: a prospective randomized, controlled trial. J Arthroplasty 2011; 26 (04) 519-522
  • 9 Demirkale I, Tecimel O, Sesen H, Kilicarslan K, Altay M, Dogan M. Nondrainage decreases blood transfusion need and infection rate in bilateral total knee arthroplasty. J Arthroplasty 2014; 29 (05) 993-997
  • 10 Fan Y, Liu Y, Lin J. , et al. Drainage does not promote post-operative rehabilitation after bilateral total knee arthroplasties compared with nondrainage. Chin Med Sci J 2013; 28 (04) 206-210
  • 11 Minnema B, Vearncombe M, Augustin A, Gollish J, Simor AE. Risk factors for surgical-site infection following primary total knee arthroplasty. Infect Control Hosp Epidemiol 2004; 25 (06) 477-480
  • 12 Ovadia D, Luger E, Bickels J, Menachem A, Dekel S. Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 1997; 12 (03) 317-321
  • 13 Willemen D, Paul J, White SH, Crook DW. Closed suction drainage following knee arthroplasty. Effectiveness and risks. Clin Orthop Relat Res 1991; (264) 232-234
  • 14 Leeman MF, Costa ML, Costello E, Edwards D. Timing of re-transfusion drain removal following total knee replacement. Ann R Coll Surg Engl 2006; 88 (02) 134-135
  • 15 Zamora-Navas P, Collado-Torres F, de la Torre-Solís F. Closed suction drainage after knee arthroplasty. A prospective study of the effectiveness of the operation and of bacterial contamination. Acta Orthop Belg 1999; 65 (01) 44-47
  • 16 Senthil Kumar G, Von Arx OA, Pozo JL. Rate of blood loss over 48 hours following total knee replacement. Knee 2005; 12 (04) 307-309
  • 17 Chandratreya A, Giannikas K, Livesley P. To drain or not drain: literature versus practice. J R Coll Surg Edinb 1998; 43 (06) 404-406
  • 18 Corpe RS, Gallentine JW, Young TR, Steflik DE, Rectinwald EJ, Kusuma S. Complications in total knee arthroplasty with and without surgical drainage. J South Orthop Assoc 2000; 9 (03) 207-212
  • 19 Drinkwater CJ, Neil MJ. Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 1995; 10 (02) 185-189
  • 20 Märdian S, Perka C, Matziolis G. Wound drainage in primary knee arthroplasty--a prospective randomized study. Acta Chir Orthop Traumatol Cech 2013; 80 (02) 114-117
  • 21 Ares-Rodriguez O, Martinez AH, Fernandez AH, Castellet E, Quilis AN. Survival curve and factors related to drainage during the first 24 h after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16 (06) 585-589
  • 22 Ares O, Seijas R, Hernandez A, Castellet E, Sallent A. Knee arthroplasty and bleeding: when to remove drainages. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 393-397
  • 23 Huang Z, Ma J, Shen B, Pei F. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29 (12) 2342-2346
  • 24 Mutsuzaki H, Ikeda K. Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty. J Orthop Surg Res 2012; 29 (07) 32
  • 25 Chareancholvanich K, Siriwattanasakul P, Narkbunnam R, Pornrattanamaneewong C. Temporary clamping of drain combined with tranexamic acid reduce blood loss after total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord 2012; 13 (13) 124
  • 26 Tan J, Chen H, Liu Q, Chen C, Huang W. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res 2013; 184 (02) 880-887
  • 27 Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 2013; 20 (05) 300-309
  • 28 American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology 2015; 122 (02) 241-275
  • 29 Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology 1983; 58 (03) 277-280