الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Introduction
KA can result in a considerable amount of blood loss. Most bleeding in TKAs occurs in the first postoperative hours. Drains in arthroplasty have been used historically for the theoretical preventing hematoma formation at the surgical site, decreasing tension over the incision (which consequently decreases pain), reducing the retardation of wound healing and reducing the risk of infection.(24,16)
Objectives:
The aim of this study is evaluation and comparing the difference in postoperative blood loss and inflammatory response between patients with a drain and those with no drain after primary TKA. Other outcomes (infection, wound healing, PE, DVT and LOS) were also assessed.
Patients and Methods:
Forty consecutive patients who underwent primary Total Knee Arthroplasty between October 2020 to May 2022 were included in the study. 20 patients were included in the group D (drain used) and 20 patients were in the group ND (no drain used). The patients were followed up postoperatively on the 7TH day and then weekly for 3 weeks and finally after 6 months postoperative. Spinal, combined with epidural anesthesia were used in all cases. The standard surgical steps were followed.
T
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Pneumatic tourniquet was used in all the cases and was deflated prior to closure to catch the bleeders. The closed suction drain used in the group D. Thick compression dressing was done in all the patients post-operatively. Similar pain management protocols were followed in both the groups. Drain removal for all the patients in group D was done after 24 hours postoperatively. Blood transfusion was recommended for patients with postoperative Hb ≤ 8 g/dL.(27) The primary outcome measures assessed were hemoglobin and HCT on 2nd and 7th postoperative days. Postoperative visible total blood loss was assessed in both groups. The secondary outcome measure assessed was the inflammatory response by detecting the behavior of CRP and ESR levels in 7th postoperative days then weekly for the next three weeks and 6 months postoperative.(18) Complications (infection, DVT, PE and wound healing) and postoperative LOS were all assessed.
Results
There was a statistically significant difference in postoperative blood loss and the need for blood transfusion between the two groups. In drain group, the blood loss and the number of patients who needed transfusion was significantly more. There was no significant difference between the two groups in respect to behavior of ESR and CRP as an indicator for inflammatory response. Ecchymosis around wound was recorded in 1 patients (5%) in D group and 5 patients (25%) in ND group with no statistically significant difference (p = 0.077) and resolved completely in all patients by the 4th week without any signs of wound infection. There were no recorded cases with infection, DVT or PE. Mean postoperative LOS for both groups were 2.98 ranging from 2 to 4 days.
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Discussion
Use of a drain in arthroplasty remains controversial and should be reconsidered by surgeons. Our study showed that both Hb and HCT% readings are significantly less in patients with drain. Visible postoperative blood loss and the amount of transfused blood, in patients without drains is significantly lower than in those with drains. Some researchers have reported similar findings, in a systematic review of Parker et. al. investigated the utility of closed suction drainage after TKA surgery.(8) They did not find benefit to the use of drain. The blood loss and the blood transfusion requirement were comparatively more with drains leading to a greater rate of transfusion. Our study provides further evidence to support the conclusion of the prospective, randomized study of drainage in knee arthroplasty carried out by Li et al.(49) In a study on 100 knee arthroplasties, Esler et al. also had similar findings with regard to blood loss and the need for blood transfusion.(10)
We found no significant difference in the incidence of infection because no infection was detected from the current study. Same results were reported in two studies by Li et al.(49) and Esler et al.(10) In the meta-analysis of Zhang et al.(3) there was also no significant difference between drainage and non-drainage in the incidence of infection. Minnema et al. in their case–control study, concluded that the use of closed suction drainage was associated with the development of SSI following TKA.(46)
We found no significant difference statistically between the two groups in the behavior of ESR and CRP as indicators for the
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inflammatory response postoperatively. The readings of ESR and CRP were in a declining manner in both groups.
Conclusion
Based on our observations and results, there is no added advantage of closed suction drain over no drain usage after TKA. The blood loss and the need for blood transfusion were significantly more when using a drain. There was no significant difference in inflammatory response, infection rate, ecchymosis around wound, LOS, PE and DVT.
Strengths
This study is a randomized prospective controlled study.
Weaknesses
Small sample size which may affect on accuracy and reality of the results. Also the relative short follow up is a disadvantage to our study.
Future recommendation and research
A larger sample size is needed to identify factors that predict outcome and different management strategies to achieve the best outcome.