CLOSED WOUND DRAINAGE IN TOTAL HIP AND TOTAL KNEE ARTHROPLASTY

Abstract

Controversy exists regarding the use of closed suction drainage in Total hip and Total knee replacement. A retrospective study on hip and knee arthroplasties was carried out to assess the efficacy of postoperative wound drainage. Twenty-five consecutive hip replacements and twenty -five consecutive knee replacements had closed wound drainage for twenty-four to forty-eight hours after the surgery while twenty-five patients in each group did not.

All operations were carried out using similar operative technique under the care of a single surgical team. Perioperative protocol for thromboprophyaxis, antibiotics, dressing and postoperative mobilisation was similar in all the patients. Thromboprophylaxis consisted of 5000 units of Fragmin daily for five days and 75 mg of Aspirin for six weeks from the day of operation.

Antibiotic prophylaxis consisted of three doses of intravenous Cefuroxime perioperatively. The hospital records including the physiotherapy and nursing notes were used for data collection. Patients were evaluated for preoperative and postoperative haemoglobin levels, the amount of blood transfused, hospital stay, functional outcome in terms of range of motion and complications. The average period of follow -up was one year.

The study showed no difference in the drop in haemoglobin levels between the drained and the undrained hips. However, the drained knees had a greater fall in haemoglobin levels postoperatively compared to the undrained. In both hip and knee arthroplasties, a larger volume of blood had to be transfused in patients with drains than those without. There was no difference between the drained and undrained patients in both the hip and knee groups in terms of hospital stay, range of movements and incidence of complications. Our preliminary study suggests that Total hip and Total Knee replacement without the use of postoperative drainage is a safe procedure. The study has financial and clinical implications.