Department of Orthopaedics, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA.
Geisinger Commonwealth School of Medicine, 525 Pine St., Scranton, PA, 18501, USA.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3565-3571. doi: 10.1007/s00402-024-05474-4. Epub 2024 Aug 6.
The use of drains after primary total joint arthroplasty (TJA) has shown little benefit. Few studies have investigated drain usage after revision TJA. The purpose of this study was to determine whether utilizing suction drains is beneficial for patients undergoing revision arthroplasty.
We performed a comprehensive literature review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from the PubMed, Embase, Web of Science, and Cochrane Library. Inclusion criteria of this review were all original articles written in English investigating the efficacy and safety of closed suction drainage in revision TKA or THA, reporting at least one of the following outcome measures: (1) estimated blood loss (EBL), (2) perioperative hemoglobin change, (3) needs for transfusion, (4) postoperative infection, and (5) wound complications. Articles were excluded if they are not available in English or they included case reports, systematic reviews, comments, editorials, surveys, or animal studies prior to July 22, 2023. A total of six studies met inclusion criteria. In total, 655 patients had a drain while 1765 patients did not have a drain after revision total hip or knee arthroplasty. Primary outcomes included for meta-analysis included estimated blood loss (EBL), postoperative hemoglobin, need for transfusion. Other data extracted includes postoperative infections, and wound complications.
Six studies met the inclusion criteria. In total, 655 patients had drains, while 1765 patients did not after revision total hip or knee arthroplasty. The average age of the patients was 66.1+/- 3.4 years, and the average BMI was 30.3 +/-0.8. There was no difference in postoperative infections (p = 0.14), wound complications (p = 0.621) or need for transfusion (p = 0.521) between the two groups. There was also no difference in EBL (Hedges' g CI[-3.52, 2.77]) or postoperative Hb (Hedges' g CI[-1.65, 2.41]) between patients with and without drains.
Our results do not show any benefit from drain placement after revision total hip or knee arthroplasty. With the increased cost, time and need for drain removal, this is likely an unnecessary intervention.
Level III, systematic review and meta-analysis.
初次全关节置换术后使用引流管的效果益处甚微。很少有研究调查过翻修全关节置换术后引流管的使用情况。本研究旨在确定在翻修关节置换术中使用负压引流是否对患者有益。
我们按照 PRISMA 指南，从 PubMed、Embase、Web of Science 和 Cochrane Library 中进行了全面的文献回顾。本综述的纳入标准为所有以英文发表的、研究闭合式负压引流在翻修 TKA 或 THA 中的疗效和安全性的原始文章，报告至少以下一个结果指标：（1）估计失血量（EBL），（2）围手术期血红蛋白变化，（3）输血需求，（4）术后感染，（5）伤口并发症。如果文章不是英文的，或者是病例报告、系统评价、评论、社论、调查或动物研究，且发表日期早于 2023 年 7 月 22 日，则将其排除在外。共有 6 项研究符合纳入标准。共有 655 例患者在翻修全髋关节或膝关节置换术后使用引流管，而 1765 例患者未使用引流管。Meta 分析的主要结果包括估计失血量（EBL）、术后血红蛋白、输血需求。还提取了其他数据，包括术后感染和伤口并发症。
有 6 项研究符合纳入标准。共有 655 例患者在翻修全髋关节或膝关节置换术后使用引流管，而 1765 例患者未使用引流管。患者的平均年龄为 66.1+/- 3.4 岁，平均 BMI 为 30.3 +/-0.8。两组患者术后感染率（p=0.14）、伤口并发症发生率（p=0.621）或输血需求（p=0.521）无差异。两组患者的 EBL（Hedges' g CI[-3.52, 2.77]）或术后 Hb（Hedges' g CI[-1.65, 2.41]）也无差异。
我们的结果表明，在翻修全髋关节或膝关节置换术后放置引流管并没有任何益处。由于增加了成本、时间和引流管去除的需要，这可能是一种不必要的干预。
三级，系统评价和荟萃分析。
