a prospective randomized controlled trial of the use of drains in total hip arthroplasty

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.

Continue :Continue :

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.