Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India.
Department of Orthopaedics, Siddharth Municipal Hospital, Mumbai, India.
Clin Orthop Surg. 2019 Mar;11(1):73-81. doi: 10.4055/cios.2019.11.1.73. Epub 2019 Feb 18.
Postoperative suction drains are used after total knee arthroplasty to avoid intra-articular hematoma formation although they can increase blood loss due to a negative suction effect. The use of tranexamic acid to reduce blood loss may nullify this. The aim of this study was to compare outcomes in patients undergoing total knee arthroplasty with or without drains and to analyze whether the drain's diameter also has an impact.
This is a prospective randomized study of patients undergoing unilateral total knee arthroplasty performed by a single surgeon. The study population was divided into three groups (A, 10G drain; B, 12G drain; and C, no drain). Pain, blood loss, swelling, wound-related complications, functional outcomes and questionnaire-based outcomes were assessed postoperatively.
Each group had 35 patients comparable in most demographic and pre- and intraoperative characteristics. During the first 6 hours postoperatively, opioid consumption was significantly higher when the drain was not used ( = 0.036). At 3 months postoperatively, new Knee Society Score (NKSS) was highest with the use of 12G drain ( = 0.018). However, NKSS at 1 year was comparable across the three groups. With the use of tranexamic acid, blood loss and incidence of soakage of dressing were unaffected by the presence or absence of a drain. The calf girth, suprapatellar girth, soakage of dressing and range of motion were comparable in all three groups. There was no incidence of surgical site infection or deep vein thrombosis.
Presence of a suction drain significantly reduces opioid consumption during the first 6 hours after total knee arthroplasty. Use of a drain made no difference to the functional outcome at 1 year postoperatively. With the use of tranexamic acid in total knee arthroplasty, the total blood loss and the requirement of blood transfusion were unaffected by the presence or absence of closed suction drainage or by the bore of the drain used. The clinical parameters such as swelling, range of motion, infection and deep vein thrombosis also remained the same.
全膝关节置换术后使用引流管以避免关节内血肿形成，尽管它们会通过负压吸引效应增加失血。使用氨甲环酸减少失血可能会使这种情况无效。本研究的目的是比较使用和不使用引流管的全膝关节置换术患者的结果，并分析引流管的直径是否也有影响。
这是一项由一位外科医生进行的单侧全膝关节置换术的前瞻性随机研究。研究人群分为三组（A 组，10G 引流管；B 组，12G 引流管；C 组，无引流管）。术后评估疼痛、失血、肿胀、伤口相关并发症、功能结果和基于问卷的结果。
每组 35 例患者在大多数人口统计学、术前和术中特征方面具有可比性。术后 6 小时内，不使用引流管时阿片类药物的消耗明显更高（=0.036）。术后 3 个月，使用 12G 引流管时新膝关节学会评分（NKSS）最高（=0.018）。然而，三组在 1 年后的 NKSS 相似。使用氨甲环酸后，引流管的存在与否对失血和敷料浸湿的发生率没有影响。三组的小腿围、髌上围、敷料浸湿和活动范围均相似。无一例发生手术部位感染或深静脉血栓形成。
引流管的存在显著减少了全膝关节置换术后 6 小时内的阿片类药物消耗。术后 1 年使用引流管对功能结果没有影响。在全膝关节置换术中使用氨甲环酸，引流管的存在与否以及引流管的内径对总失血量和输血需求没有影响。肿胀、活动范围、感染和深静脉血栓形成等临床参数也保持不变。
