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


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


  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.

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