Abstract
Introduction
The issue regarding whether suction drainage should be used during TKA continues to be debated as both methods have disadvantages. The use of a drain may increase estimated blood loss and incidence of blood transfusion, while no drainage may be associated with ecchymosis formation surrounding the surgical site and wound problems. This prospective randomized study aimed to clarify the need for suction drainage in TKA by assessing the short-term postoperative outcome.
Patients and Methods
We randomized 39 patients undergoing TKAs either with or without an intra-articular suction drain and divided to two groups. All the TKAs were performed by a single surgeon using cemented prostheses. As the perioperative blood management, air tourniquet was used during surgery, the knee arthrotomy was closed water-tightly, and all the patients were received both intra-articular and intra-venous administrations of tranexamic acid. After the surgery, a bulky compression dressing was applied to prevent the third space leakage of the blood for four days and rivaroxaban was used for venous thromboembolism prophylaxis for one week. The two groups were compared in terms of hemoglobin decrease, recovery of knee flexion, postoperative pain, and examined both the knee circumference and knee swelling. The incidence of short-term complications also evaluated.
Results
TKAs were performed in 24 patients with (Group 1) and 15 patients without (Group 2) suction drain and there was no major complication in both groups. We found no significant differences in the mean postoperative blood loss, postoperative pain, and ROM during two weeks after TKA between the two groups. The amount of the intra-articular fluid measured with computed tomography as the postoperative knee swelling was similar between the two groups.
Discussion and Conclusions
Recently, as the pharmacologic agents have been routinely used for venous thromboembolism prophylaxis after TKA for more than one week, perioperative bleeding should be managed more intensively. The administration of tranexamic acid has been widely reported to decrease the postoperative blood loss, and water-tightness of the arthrotomy closure can reduce hemarthrosis and arthrotomy leakage to the third space by a tamponade effect. The advantage of the bulky compression dressing reportedly is to reduce soft tissue edema and bleeding in an effort to promote venous drainage. Furthermore, this study did not demonstrate that intra-articular suction drain contributed to decrease the amount of intra-articular fluid at two weeks after the surgery. In conclusion, under the condition of routine pharmacologic VTE prophylaxis with intensive perioperative blood management, intra-articular suction drain has no advantage in TKA.
