Subcutaneous versus intraarticular indwelling closed suction drainage after TKA: a randomized controlled trial.
BACKGROUND
TKA can involve substantial bleeding, and the issue regarding whether vacuum drainage should be used during TKA continues to be debated as both methods have disadvantages.


OBJECTIVE
We therefore asked whether subcutaneous indwelling vacuum drainage is advantageous over intraarticular indwelling vacuum drainage in terms of blood drainage, bleeding-related complications, and functional outcomes in primary TKA.


METHODS
We randomized 111 patients undergoing TKAs to have either a subcutaneous indwelling or an intraarticular indwelling catheter and compared the two groups for blood loss (hemoglobin decrease, transfusion requirements, hypotension episode), incidence of wound problems (requirements for dressing reinforcement, oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes (recovery of motion arc, American Knee Society, WOMAC, and SF-36 scores) at 12 months after surgery.


RESULTS
The mean vacuum drainage volume was less in the subcutaneous indwelling group than in the intraarticular indwelling group (140 mL versus 352 mL). The groups were similar in terms of decreases in hemoglobin after 2 and 5 days (3.0 versus 3.3 g/dL and 3.3 versus 3.7 g/dL, respectively), allogenic transfusion requirements (4% versus 11%), incidence of wound problems, and functional scores.


CONCLUSIONS
The data suggest subcutaneous indwelling closed-suction drainage is a reasonable alternative to intraarticular indwelling closed-suction drainage and to no suction drainage.


METHODS
Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Seo
Eun Seok
ES
Department of Orthopaedic Surgery, Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
Yoon
Su Won
SW
Koh
In Jun
IJ
Chang
Chong Bum
CB
Kim
Tae Kyun
TK
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical; D002408:Catheters, Indwelling; D005260:Female; D006403:Hematologic Tests; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures; D020370:Osteoarthritis, Knee / Q000601:surgery; D020127:Recovery of Function; D040521:Subcutaneous Tissue; D013396:Suction / Q000295:instrumentation / Q000379:methods; D014945:Wound Healing