Clin Orthop Surg.  2019 Mar;11(1):73-81. 10.4055/cios.2019.11.1.73.

Role of Suction Drain after Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study

• Maniar RN
• Pradhan P
• Bhatnagar
• Maniar A
• Bidwai R
• Bindal P

• KMID: 2438336
• DOI: http://doi.org/10.4055/cios.2019.11.1.73

Abstract

BACKGROUND
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.
METHODS
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.
RESULTS
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 (p = 0.036). At 3 months postoperatively, new Knee Society Score (NKSS) was highest with the use of 12G drain (p = 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.
CONCLUSIONS
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.

Keyword

Knee osteoarthritis; Arthroplasty; Drainage; Tranexamic acid

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Knee*
Bandages
Blood Transfusion
Drainage
Hematoma
Humans
Incidence
Knee*
Osteoarthritis, Knee
Prospective Studies
Range of Motion, Articular
Suction*
Surgical Wound Infection
Tranexamic Acid*
Venous Thrombosis
Tranexamic Acid

Figure

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  Fig. 1 Consolidated standards of reporting trials diagram depicting flow of study participants.

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  Fig. 2 Line diagram illustrating the trend of increase and subsequent decrease in suprapatellar (SG) and calf (CG) girth measurements from 1 day before surgery to 3 months after surgery. Trend of girth measurements is comparable in groups A, B, and C. Group A: 12G (4-mm) size vacuum suction drain group, Group B: 10G (3.3-mm) size drain group, Group C: no drain group.

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  Fig. 3 Line diagram illustrating the decline and subsequent regaining of flexion at the knee after surgery. No significant differences were observed in the trend of knee range of motion between the three groups.

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