Research Article
Volume 11 Issue 7 - 2020
Are Surgical Drains Necessary in Total Hip Arthroplasty?
Sunil Sheshrao Nikose1*, Devashree Nikose2, Kiran Saoji3, Sandeep Shrivastava4 and Shashank Jain5
1Professor of Orthopedics and Director of Centre of Excellence for Simulation, Jawaharlal Nehru Medical College, Wardha, India
2Medical Doctor, BLS/ACLS Instructor, NKP Salve Institute of Medical Sciences, Nagpur, India
3Professor and Head, Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, India
4Director and Professor Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, India
5Senior resident , Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, India
*Corresponding Author: Sunil Sheshrao Nikose, Professor of Orthopedics and Director of Centre of Excellence for Simulation, Jawaharlal Nehru Medical College, Wardha, India.
Received: May 25, 2020; Published: June 24, 2020




Abstract

Background: Using a drain is a routine practice to reduce hematoma formation following a total hip arthroplasty (THA). A prospective randomized study was undertaken to compare the drain and non-drain group in terms of blood transfusion need and local complications like hematoma formation.

Methods: Total 168 patient undergoing primary THA were enrolled and randomly allocated into drainage (76 patients) and non-drainage groups (92 patients).The primary outcome measures were local complication like wound hematoma formation, patient discomfort, wound complications, and need for transfusion rates and drop in hemoglobin in postoperative phase while secondary outcome measures were estimated blood loss through the drain, length of hospital stay. All patients received intraoperative tranexamic acid as per single protocol.

Results: The intra operative blood loss during THA was comparable in both groups with all surgeons using the posterolateral approach. The drain group had more patient discomfort at local site and the approximate drain amount after 48 hours was 110 ml. The drop in hemoglobin and hematocrit level was significant in the drain group and required more transfusions as compared to non-drain group. There were equal wound related complications in both groups with 2 patients each having superficial wound infection. The hospital stay was less in non-drain group (5.2 days) as compared to drain group (7.8 days). Both groups did not require enforcement dressing and there was no peri wound ecchymosis in both the group.

Conclusion: There is no evidence to support that drains are better than no- drains and the use would be dictated by surgeons’ choice and personal preference.

Keywords: Total Hip Arthroplasty (THA); Hematoma; Hemoglobin; Tranexamic Acid; Transfusion; Ecchymosis

References

  1. Bierbaum BE., et al. “An analysis of blood management in patients having a total hip or knee arthroplasty”. Journal of Bone and Joint Surgery American 1 (1999): 2-10.
  2. Nuttall GA., et al. “The predictors of red cell transfusions in total hip arthroplasties”. Transfusion2 (1996): 144-149.
  3. Tai TW., et al. “Temporary drainage clamping after total knee arthroplasty: A meta-analysis of randomized controlled trials”. The Journal of Arthroplasty 25 (2010): 1240-1244.
  4. Zeng Wn., et al. “Comparison between drainage and non-drainage after total hip arthroplasty in Chinese subjects”. Orthopaedic Surgery 1 (2014): 28-32.
  5. Nanni M., et al. “Wound drainages in total hip arthroplasty: to use or not to use? Review of the literature on current practice”. Journal of Musculoskeletal Surgery 97 (2013): 101-107.
  6. Lindahal J., et al. “Bacterial contamination and closed suction drainage in open meniscectomy of the knee”. Annales Chirurgiae Et Gynaecologiae 82 (1993): 51-54.
  7. Niskanen RO., et al. “Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis a prospective randomized study”. The Journal of Arthroplasty 5 (2000): 567-569.
  8. Koyano G. “Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one‑stage bilateral total hip arthroplasty”. The Journal of Arthroplasty 30 (2015): 74-
  9. Parrini L., et al. “Ultrasound examination of hematomas after total hip replacement”. International Orthopaedics 12 (1988): 79-82.
  10. Sørensen AI and Sørensen TS. “Bacterial growth on suction drain tips”. Acta Orthopaedica Scandinavica 62 (1991): 451-454.
  11. David NG., et al. “To use closed suction drain or not after total hip arthroplasty; a randomized controlled trial?” Journal of Current Medical Research and Practice 3 (2018): 180-186.
  12. Kelly EG., et al. “Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty”. Surgical Technology International 24 (2014): 295-301.
  13. Widman J., et al. “No effect of drains on the postoperative hematoma volume in hip replacement surgery: a randomized study using scintigraphy”. Acta Orthopaedica Scandinavica 6 (2002): 625-629.
  14. Loh A and Jones PA. “Evisceration and other complications of abdominal drains”. Postgraduate Medical Journal 789 (1991): 687-688.
  15. Magnussen PA., et al. “A study of wound healing hematoma after hip surgery using ultrasound”. Journal of Bone and Joint Surgery 68 (1968): 497.
  16. Kumar V., et al. “Comparative study of primary total hip replacement (THR) with or without close negative suction drain”. International Journal of Orthopaedics Sciences3 (2018): 377-379.
  17. Chen ZY., et al. “Is wound drainagenecessary in hiparthroplasty? A meta-analysis of randomizedcontrolled trials”. The European Journal of Orthopaedic Surgery and Traumatology 6 (2014): 939-946.
  18. Parker M., et al. “Closed suction surgical wound drainage after orthopaedic surgery”. Cochrane Database of Systematic Reviews 3 (2007): 21-28.
  19. Esler CNA., et al. “The use of a closed suction drain in total knee arthroplasty. prospective randomised study”. The Journal Of Bone and Joint Surgery British 85 (2003): 215-217.
  20. Hill RMF and Brenkel I. “Drain vs. no drain in unilateral total hip arthroplasty: a randomised prospective trial”. The Journal of Bone and Joint Surgery British 2 (2003): 104.
  21. Ovadia D., et al. “Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study”. The Journal of Arthroplasty 12 (1997): 317-321.
  22. Kim YH., et al. “Drainage versus non drainage in simultaneous bilateral total hip arthroplasties”. The Journal of Arthroplasty 2 (1998): 185-189.
  23. Kleinert K., et al. “Closed suction drainage with or without re-transfusion offiltered shed blood does not offer advantages in primarynon-cemented total hip replacement using a direct anteriorapproach”. Archives of Orthopaedic and Trauma Surgery 1 (2012): 131-136.
  24. Von Roth P., et al. “Use of Redon drains in primary total hiparthroplasty has no clinically relevant benefits”. Orthopedics 11 (2012): e1592-e1595.
  25. Holt BT., et al. “Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty”. Orthopedics12 (1997): 1121-1124.
  26. Della Valle AG., et al. “No need for routine closed suction drainage in elective arthroplasty of the hip. A prospective randomized trial in 104 operations”. Acta Orthopaedica Scandinavica 75 (2004): 30-33.
  27. Waugh TR and Stinchfield FE. “Suction drainage of orthopaedic wounds”. Journal of Bone and Joint Surgery American 43 (1961): 939-946.
  28. Beer KJ., et al. “The efficacy of suction drains after routine total joint arthroplasty”. Journal of Bone and Joint Surgery American 4 (1991): 584-587.
  29. Ritter MA., et al. “Closed wound drainage in total hip or total knee replacement. A prospective, randomized study”. Journal of Bone and Joint Surgery American 1 (1994): 35-38.
  30. Walmsley PJ., et al. “A prospective randomized controlled trial of the use of drain in total hip arthroplasty”. Journal of Bone and Joint Surgery 87 (2005): 1397-1401.
Citation: Sunil Sheshrao Nikose., et al. “Are Surgical Drains Necessary in Total Hip Arthroplasty?”. EC Orthopaedics 11.7 (2020): 85-90.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for August Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the August issue of respective journals. Submissions are accepted on/before July 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk