Short duration and low suction pressure drain versus no drain following total knee replacement

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.

Do tourniquet and drainage influence fast track in total knee arthroplasty? Our results on 151 cases

Background: Fast track in total knee replacement (TKR) is a widely used protocol. Tranexamic acid proved to be effective in reducing perioperative bleeding without increasing thromboembolic risk. The aim of this study was to assess if tourniquet and suction drainage might affect perioperative blood loss and post-operative functional recovery after TKR. Methods: 151 patients, who underwent to TKR, were assessed and divided into three homogeneous groups: group A (51 patients) in which both tourniquet and suction drainage have been applied (tourniquet has been release before wound closure); group B (50 patients) in which neither tourniquet nor suction drainage have been used; group C (50 patients) in which only tourniquet has been used. Perioperative intravenous tranexamic acid and post-operative low-molecular-weight heparin have been administered. Trend of haemoglobin values, transfusion rate, pain, ability to obtain 90 degrees of flexion and length of stay were analysed. Results: The average intra-operative blood loss was statistically higher in group B in comparison to other two groups. Haemoglobin values were lower in group A in comparison to group C in the third and fifth post-operative days. Patients in group A had higher transfusion rate, higher pain and had more difficulties in reaching a 90 degrees of knee flexion than the other two groups. There was one infection in group A. No differences in length of stay. Conclusion: Suction drain seems to be associated to lower haemoglobin values, higher transfusion rate, higher pain and slower functional recovery. Short-term tourniquet does not influence post-operative bleeding and rehabilitation program. (www.actabiomedica.it)

Blood-Sparing Efficacy of Oral Tranexamic Acid in Primary Total Hip Arthroplasty

BACKGROUND

Tranexamic acid (TXA) has been shown to be effective in reducing blood loss, hemoglobin drop, and blood transfusion in primary total hip arthroplasty. Most studies used intravenous form or topical form. This study was to assess the blood-sparing efficacy and safety of oral TXA in total hip arthroplasty.

METHODS

Patients with primary total hip arthroplasty from 2012 to 2015 were recruited. Trial group with 1 gm of oral TXA 2 hours preoperatively, and 6 hours and 12 hours postoperatively was compared with the control group without drug. Outcome measures were intraoperative blood loss, drain output, observed total blood loss, actual total blood loss, hidden blood loss, hemoglobin drop, blood transfusion requirement, thromboembolic complications, cerebrovascular or cardiovascular complications, and mortality.

RESULTS

After exclusion, 108 patients were included-54 in trial group and 54 in control group. There was no significant difference in the baseline characteristics. The trial group had significantly higher postoperative hemoglobin (10.3 vs 9.4 g/dL), lower hemoglobin drop (3.0 vs 4.1 g/dL), lower hidden blood loss (149 vs 354 mL), and lower actual total blood loss (847 vs 1096 mL). There was no significant difference in thromboembolic complications or mortality. There was also no periprosthetic infection or drug allergy.

CONCLUSION

Oral TXA is effective in blood sparing in terms of reduction in hemoglobin drop, hidden blood loss, and actual total blood loss. It is safe and is an alternative to the intravenous or topical form.