a prospective randomized controlled trial of the use of drains in total hip arthroplasty
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A Prospective Randomized Controlled Trial of the Use of Drains in Total Hip Arthroplasty. Presented By : Dr. Abdulrahman Algarni. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
A Prospective A Prospective Randomized Controlled Randomized Controlled
Trial of the Use of Trial of the Use of Drains in Total Hip Drains in Total Hip
ArthroplastyArthroplasty
A Prospective A Prospective Randomized Controlled Randomized Controlled
Trial of the Use of Trial of the Use of Drains in Total Hip Drains in Total Hip
ArthroplastyArthroplasty
Presented By :Presented By :
Dr. Abdulrahman Algarni Dr. Abdulrahman Algarni
IntroductionIntroduction
Drains are used commonly in Drains are used commonly in
orthopedic surgery particularly orthopedic surgery particularly
arthroplasty principally to reduce the arthroplasty principally to reduce the
formation of hematoma which formation of hematoma which
increase tension and reduce perfusion increase tension and reduce perfusion
of tissues as well as providing medium of tissues as well as providing medium
for infection.for infection.
Literature is conflicting.Literature is conflicting.
Recent Meta-Analysis suggested that Recent Meta-Analysis suggested that
the only proven benefit is a reduced the only proven benefit is a reduced
need for the change of dressings.need for the change of dressings.
The aim is to evaluate the routine use The aim is to evaluate the routine use
of drains in T.H.A. with follow-up of 3 of drains in T.H.A. with follow-up of 3
years. years.
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Patients and MethodsPatients and Methods 552 patients, at two hospitals, Six 552 patients, at two hospitals, Six
consultants .consultants .
Sep. 1997 and Dec. 2000.Sep. 1997 and Dec. 2000.
Revisions or preoperative skin Revisions or preoperative skin
pathology patients are excluded.pathology patients are excluded.
Age, gender, BMI, Primary hip Age, gender, BMI, Primary hip
disorder past medical history, Hb, HHS disorder past medical history, Hb, HHS
and concomitant medical problems and concomitant medical problems
were obtained.were obtained.
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Arthroplasty research nurse, who was Arthroplasty research nurse, who was
blinded, collected the data. blinded, collected the data.
LMWH (Deltaparin 5000IU), Elastic LMWH (Deltaparin 5000IU), Elastic
stockings IV Cefuroxime, Elite Plus or stockings IV Cefuroxime, Elite Plus or
Charnley prostheses, Anterolateral Charnley prostheses, Anterolateral
approach.approach.
At the end of procedure, they were At the end of procedure, they were
randomised by opaque randomised by opaque –– numbered numbered
envelops to either no drain or a 3 mm envelops to either no drain or a 3 mm
Redivac drain which was removed at 24 Redivac drain which was removed at 24
hrs. hrs.
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Postop. Hb at 24 hrs.Postop. Hb at 24 hrs.
If Hb < 8 g/dl or < 10 g/dl and If Hb < 8 g/dl or < 10 g/dl and
symptomatic 2 U PRBC allogenic were symptomatic 2 U PRBC allogenic were
transfused.transfused.
Follow up at 6, 18 and 36 months : Follow up at 6, 18 and 36 months :
Radiographs and HHS obtained.Radiographs and HHS obtained.
P value < 0.05 was considered P value < 0.05 was considered
significant. significant.
ResultsResults
Of the 552, 25 had B/L THA.Of the 552, 25 had B/L THA.
In the drained group : 9% (25 In the drained group : 9% (25
of 282) with incomplete follow-of 282) with incomplete follow-
up Vs. 8% (23 of 295) in the up Vs. 8% (23 of 295) in the
undrained group. undrained group.
DiscussionDiscussion
The only clear benefit is reduced need The only clear benefit is reduced need
for change of dressing. for change of dressing.
Most studies which identify an Most studies which identify an
increased incidence of hematoma, increased incidence of hematoma,
swelling and bruising if a drain is not swelling and bruising if a drain is not
used fail to report any serious adverse used fail to report any serious adverse
outcomes.outcomes.
Most studies report < 2% deep infection Most studies report < 2% deep infection
rate.rate.
Divergence of opinion about rates Divergence of opinion about rates
of transfusion and the use of of transfusion and the use of
drains. drains.
No difference in other outcome No difference in other outcome
measures of revision, DVT-PE, measures of revision, DVT-PE,
Postop, Hb, HHS and length of Postop, Hb, HHS and length of
hospital stay.hospital stay.
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ConclusionConclusion
Drains provide no advantage to Drains provide no advantage to
patients undergoing THA, represent an patients undergoing THA, represent an
additional cost and expose the patient additional cost and expose the patient
to potentially adverse effects such as to potentially adverse effects such as
blood transfusion. blood transfusion.
We would recommend discontinuing the We would recommend discontinuing the
routine use of drains at uncomplicated routine use of drains at uncomplicated
T.H.A.T.H.A.