Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations.
BACKGROUND
Evidence to support or refute closed suction drainage (CSD) in primary total hip replacement (THR) is not conclusive. Our anecdotical experience was that persistent ooze from the drainage hole often delayed wound recovery. We hypothesized that, without CSD, wound care would be simplified without short or long term disadvantage.


METHODS
Hundred patients scheduled for primary THR were randomly assigned for CSD or non-drainage. Drains were withdrawn at day 2. Pain, wound hematoma, number of dressing changes, time of persistent discharge from the operation site (skin incision and drain hole), total blood loss and number of blood transfusions were prospectively recorded. Hip function, presence of heterotopic ossifications (HTO) and complications were recorded at a follow visit 1 year after surgery.


RESULTS
Wound sites managed without CSD needed significantly less wound dressings (P < 0.001) and were dry at an earlier time (P < 001). Despite a significant bigger subfascial hematoma in the non-drained group (P < 0.05), in terms of pain, thigh swelling, total blood loss, number of transfusions needed, hip function and HTO no difference was recorded between the groups (P = 0.2-0.82).


CONCLUSIONS
To omit CSD in primary THR results in simplified and more rapid wound management without any disadvantage at short and long term.
Dora
Claudio
C
Department of Orthopedic Surgery, Balgrist Clinic, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland. claudio.dora@balgrist.ch
von Campe
Arndt
A
Mengiardi
Bernhard
B
Koch
Peter
P
Vienne
Patrick
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001458:Bandages / Q000706:statistics & numerical data; D004322:Drainage; D005205:Fascia; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D013396:Suction; D014945:Wound Healing