Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study

Paweł Bartosz, Wojciech Marczyński, Marcin Para, Maciej Kogut, Jerzy Białecki, Paweł Bartosz, Wojciech Marczyński, Marcin Para, Maciej Kogut, Jerzy Białecki

Abstract

Background: The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis.

Methods: In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days.

Results: The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group.

Conclusions: We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings.

Trial registration: The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.

Keywords: Cementless hip replacement; Hematoma; Suction drainage; Surgical outcomes.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of patient allocation and randomization process

References

    1. Learmonth ID, Young C, Rorabec C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–19. doi: 10.1016/S0140-6736(07)60457-7.
    1. Chen S, Wu K, Kong G, Feng W, Deng Z, Wang H. The efficacy of topical tranexamic acid in total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2016;17:81. doi: 10.1186/s12891-016-0923-0.
    1. Ghadimi K, Levy JH, Welsby IJ. Perioperative management of the bleeding patient. Br J Anaesth. 2016;117:iii18–30. doi: 10.1093/bja/aew358.
    1. Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, et al. Predictors of wound infection in hip and knee joint replacement: results from a 20-year surveillance program. J Orthop Res. 2002;20:506–15. doi: 10.1016/S0736-0266(01)00153-X.
    1. Lee GW, Park KS, Kim DY, Shin YR, Yoon TR. New strategy of closed suction drainage after primary total hip arthroplasty. Acta Orthop Traumatol Turc. 2017;51:223–6. doi: 10.1016/j.aott.2017.02.010.
    1. Białecki J, Bartosz P, Marczyński W, Zając J. Usefulness of ultrasonography in the diagnosis of hematoma after primary hip arthroplasty. J Ultrason. 2017;17:149–53. doi: 10.15557/JoU.2017.0022.
    1. Mortazavi SM, Hansen P, Zmistowski B, Kane PW, Restrepo C, Parvizi J. Hematoma following primary total hip arthroplasty: a grave complication. J Arthroplasty. 2013;28:498–503. doi: 10.1016/j.arth.2012.07.033.
    1. Chmielewski D, Górecki A, Kusz D, Małdyk P, Marczyński W, Tomkowski W. [Principles of prevention of venous thromboembolism in orthopedics and traumatology (updated on 02/18/2014)] Ortop Traumatol Rehabil. 2014;16:227–39.
    1. Fagotti L, Ejnisman L, Miyahara HS, Gurgel HMC, Croci AT, Vicente JRN. Use of closed suction drainage after primary total hip arthroplasty: a prospective randomized controlled trial. Rev Bras Ortop. 2018;53:236–43. doi: 10.1016/j.rbo.2017.03.024.
    1. Gibon E, Courpied JP, Hamadouche M. Total joint replacement and blood loss: what is the best equation? Int Orthop. 2013;37:735–9. doi: 10.1007/s00264-013-1801-0.
    1. Brismar BH, Hallert O, Tedhamre A, Lindgren JU. Early gain in pain reduction and hip function, but more complications following the direct anterior minimally invasive approach for total hip arthroplasty: a randomized trial of 100 patients with 5 years of follow up. Acta Orthop. 2018;89:484–9. doi: 10.1080/17453674.2018.1504505.
    1. Hou N, Jing F, Rong W, He DW, Zhu JJ, Fang L, et al. [Meta analysis of the efficacy and safety of drainage after total hip arthroplasty] Zhonghua Yi Xue Za Zhi. 2017;97:1668–72.
    1. Yumoto T, Joko R, Yamakawa Y, Yamada T, Naito H, Nakao A. Subperiosteal hematoma of the iliac bone: an unusual cause of acute hip pain after a fall. Am J Case Rep. 2018;19:1083–6. doi: 10.12659/AJCR.910010.
    1. Zeng WN, Zhou K, Zhou ZK, Shen B, Yang J, Kang PD, et al. Comparison between drainage and no-drainage after total hip replacement in Chinese subjects. Orthop Surg. 2014;6:28–32. doi: 10.1111/os.12092.
    1. Chen ZY, Gao Y, Chen W, Li X, Zhang YZ. Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2014;24:939–46. doi: 10.1007/s00590-013-1284-0.
    1. Waugh TR, Stinchfield FE. Suction drainage of orthopaedic wounds. J Bone Joint Surg Am. 1961;43–A:939–46. doi: 10.2106/00004623-196143070-00002.
    1. Murphy JP, Scott JE. The effectiveness of suction drainage in total hip arthroplasty. J R Soc Med. 1993;86:388–9.
    1. Hadden WA, McFarlane AG. A comparative study of closed-wound suction drainage vs. no drainage in total hip arthroplasty. J Arthroplasty. 1990;5;Suppl:21–4. doi: 10.1016/S0883-5403(08)80021-6.
    1. Walmsley PJ, Kelly MB, Hill RM, Brenkel I. A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br. 2005;87:1397–401. doi: 10.1302/0301-620X.87B10.16221.
    1. Zimmerli W. Clinical presentation and treatment of orthopaedic implant-associated infection. J Intern Med. 2014;276:111–9. doi: 10.1111/joim.12233.
    1. Kelly EG, Cashman JP, Imran FH, Conroy R, O’Byrne J. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty. Surg Technol Int. 2014;24:295–301.
    1. Suarez JC, McNamara CA, Barksdale LC, Calvo C, Szubski CR, Patel PD. Closed suction drainage has no benefits in anterior hip arthroplasty: a prospective, randomized trial. J Arthroplasty. 2016;31:1954–8. doi: 10.1016/j.arth.2016.02.048.
    1. Salt E, Wiggins AT, Rayens MK, Brown K, Eckmann K, Johannemann A, et al. Risk factors for transfusions following total joint arthroplasty in patients with rheumatoid arthritis. J Clin Rheumatol. 2018;24:422–6. doi: 10.1097/RHU.0000000000000755.

Source: PubMed

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