The Role of Drainage After Total Knee Arthroplasty

Total knee arthroplasty (TKA) is associated with significant postoperative blood loss for which blood transfusion might be necessary. The role of wound drainage is controversial. The use of drainage was believed to be effective in decreasing hematoma formation (Drinkwater and Neil 1995; Holt et al. 1997; Martin et al. 2004), which has been theoretically thought to decrease postoperative pain, swelling, and incidence of infection(Kim et al. 1998). However, a closed suction drainage system inevitably increases bleeding because the tamponade effect of a closed and undrained wound is eliminated. Though some studies have shown that drainage after TKA is not necessary(Adalberth et al. 1998; Niskanen et al. 2000; Esler et al. 2003; Parker et al. 2004; Jones et al. 2007), it is still widely used by orthopedic surgeons(Canty et al. 2003). Surgeons who routinely drain total knee replacements may also use adjunctive measures such as autologous blood transfusion, use of fibrin tissue adhesive, compression bandaging and local ice packing(Gibbons et al. 2001; Kullenberg et al. 2006; Radkowski et al. 2007) to reduce the excessive blood loss from the drain. Recently, drain clamping has received increasing attention. Since most of the blood loss in TKA occurs during the first few postoperative hours (37% in 2 hours and 55% in 4 hours)(Jou IM 1993; Senthil Kumar et al. 2005), it seems reasonable to clamp the drain tube in the first few hours after TKA to temporarily create a tamponade effect for bleeding control. Various methods of clamping drain have been reported in the literature. However, no consensus has been achieved to date. To clarify the role of drainage system after total knee arthroplasty, we conduct a review process in the present project. A comprehensive search was carried out and the articles regarding the drainage after surgery were reviewed. This review article focused on: 1. Effectiveness of postoperative drainage in TKA. 2. Safety and complications of postoperative drainage in TKA. 3. Effect of temporary drain clamping. The purpose of this article is to analyze the pros and cons in using the drainage system after total knee arthroplasty and to provide practical information for orthopedic surgeons and medical care givers.