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Subcutaneous versus intraarticular closed suction indwelling drainage after total knee arthroplasty: A randomised control trial.

Yang JH, Yoon JR, Dahuja A, Song S - Indian J Orthop (2016 Jan-Feb)

Bottom Line: Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002).Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea.

ABSTRACT

Background: Total knee arthroplasty (TKA) is widely accepted treatment for moderate or severe osteoarthritis and rheumatoid arthritis. Significant blood loss can be seen during the early postoperative period where a blood transfusion may be necessary. Closed suction drainage is known to prevent the formation of hematomas in the operative field, decrease tension on incisions, diminish delayed wound healing and reduce the risk of infection. Subcutaneous indwelling closed suction drainage method has been known to be beneficial and an alternative to the intraarticular indwelling method. This prospective randomized study was to compare the visible, hidden, total blood loss and postoperative hemodynamic change of subcutaneous and intraarticular indwelling closed suction drainage method after TKA.

Materials and methods: One hundred and sixty patients with primary osteoarthritis who underwent unilateral TKA were enrolled; group A with subcutaneous (n = 78) and group B with intraarticular (n = 79) indwelling closed suction drainage method. Total blood loss, visible blood loss, internal blood loss, postoperative day 1, 5(th), 10(th) day hemoglobin, hematocrit levels were compared. Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.

Results: Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002). Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.

Conclusion: Subcutaneous indwelling closed suction drainage method is a reasonable option after TKA for reduction of postoperative bleeding and transfusion rate.

No MeSH data available.


Related in: MedlinePlus

Flow char showing consolidated standards of reporting trials
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Figure 1: Flow char showing consolidated standards of reporting trials

Mentions: 160 patients with primary osteoarthritis, who underwent unilateral TKA in our institute between January 2011 and September 2011, were enrolled in this trial. All patients were randomly assigned into two groups (80 per group) using computer-generated numbers. The sample size was calculated to detect a significant difference in the postoperative drainage and laboratory change between groups with a power of 80% with an α value of 0.05. Group A and B were patients with subcutaneous and intraarticular indwelling closed suction drainage method, respectively. Three patients have been lost in the followup. This left 157 TKAs (78 patients for Group A and 79 patients for Group B) who form the basis of the current report [Figure 1]. Exclusion criteria include other diagnosis than primary osteoarthritis, preoperative valgus alignment, received a revision or bilateral TKA, hematological disease, previous open knee surgery or vascular surgery. There were 53 males and 104 females with an average age of 69.5 ± 5.8 years (range 61-82 years), and the average body mass index was 24.9 ± 4.7 kg/m2 [Table 1]. This study was conducted after the approval of the Institutional Review Board and informed consent was obtained from each patient before enrollment in the study.


Subcutaneous versus intraarticular closed suction indwelling drainage after total knee arthroplasty: A randomised control trial.

Yang JH, Yoon JR, Dahuja A, Song S - Indian J Orthop (2016 Jan-Feb)

Flow char showing consolidated standards of reporting trials
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4759876&req=5

Figure 1: Flow char showing consolidated standards of reporting trials
Mentions: 160 patients with primary osteoarthritis, who underwent unilateral TKA in our institute between January 2011 and September 2011, were enrolled in this trial. All patients were randomly assigned into two groups (80 per group) using computer-generated numbers. The sample size was calculated to detect a significant difference in the postoperative drainage and laboratory change between groups with a power of 80% with an α value of 0.05. Group A and B were patients with subcutaneous and intraarticular indwelling closed suction drainage method, respectively. Three patients have been lost in the followup. This left 157 TKAs (78 patients for Group A and 79 patients for Group B) who form the basis of the current report [Figure 1]. Exclusion criteria include other diagnosis than primary osteoarthritis, preoperative valgus alignment, received a revision or bilateral TKA, hematological disease, previous open knee surgery or vascular surgery. There were 53 males and 104 females with an average age of 69.5 ± 5.8 years (range 61-82 years), and the average body mass index was 24.9 ± 4.7 kg/m2 [Table 1]. This study was conducted after the approval of the Institutional Review Board and informed consent was obtained from each patient before enrollment in the study.

Bottom Line: Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002).Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea.

ABSTRACT

Background: Total knee arthroplasty (TKA) is widely accepted treatment for moderate or severe osteoarthritis and rheumatoid arthritis. Significant blood loss can be seen during the early postoperative period where a blood transfusion may be necessary. Closed suction drainage is known to prevent the formation of hematomas in the operative field, decrease tension on incisions, diminish delayed wound healing and reduce the risk of infection. Subcutaneous indwelling closed suction drainage method has been known to be beneficial and an alternative to the intraarticular indwelling method. This prospective randomized study was to compare the visible, hidden, total blood loss and postoperative hemodynamic change of subcutaneous and intraarticular indwelling closed suction drainage method after TKA.

Materials and methods: One hundred and sixty patients with primary osteoarthritis who underwent unilateral TKA were enrolled; group A with subcutaneous (n = 78) and group B with intraarticular (n = 79) indwelling closed suction drainage method. Total blood loss, visible blood loss, internal blood loss, postoperative day 1, 5(th), 10(th) day hemoglobin, hematocrit levels were compared. Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.

Results: Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002). Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.

Conclusion: Subcutaneous indwelling closed suction drainage method is a reasonable option after TKA for reduction of postoperative bleeding and transfusion rate.

No MeSH data available.


Related in: MedlinePlus