title: Autologous transfusion of drain contents in elective primary knee arthroplasty: its value and relevance.
abstract: BACKGROUND
  Total knee arthroplasty is associated with significant post-operative blood loss often necessitating blood transfusions. Blood transfusions may be associated with transfusion reactions and may transmit human immunodeficiency virus, hepatitis C virus and hepatitis B virus, with devastating consequences. After total knee arthroplasty, transfusion of the contents of an autologous drain is becoming common practice. The aim of our study was to look at the effectiveness of these drains in elective primary total knee arthroplasty.
  
  
  METHODS
  A prospective study was conducted including 70 non-randomised patients. A normal suction drain was used in 35 patients (group A), whereas in the other 35 patients, a CellTrans™ drain was used (group B). All the operations were performed by four surgeons using a tourniquet with a medial parapatellar approach. Pre- and post-operative haemoglobin concentrations were recorded in both groups. A Student's t-test was applied to determine the statistical significance of the data collected.
  
  
  RESULTS
  The average fall in post-operative haemoglobin was 3.66 g/dL (SD 1.46; range, 0.6-7.0) among patients in whom the simple drain was used (group A) and 2.29 g/dL (SD 0.92; range, 0.6-5.9) among those in whom the CellTrans™ drain was used (group B) (p<0.0001). Twenty-five units of allogeneic blood were required in group A compared to four units in group B. The rate of transfusion was 5.7% (2 patients) in the group in which CellTrans™ drain was used and 25.7% (9 patients) in the group in which a simple suction drain was used.
  
  
  CONCLUSIONS
  Total knee arthroplasty is associated with significant post-operative blood loss despite best operative technique. Autologous reinfusion of the contents of a CellTrans™ drain significantly reduces the rate of post-operative blood transfusion. This study indicates that the use of an autologous drain could be recommended as routine practice in primary total knee arthroplasty.
authors.affiliation: Trauma & Orthopaedics and Spinal Surgery, Luton and Dunstable Hospital NHS Foundation Trust, Luton, United Kingdom. orthopaediks@googlemail.com
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Singh
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Singh
authors.forename: Sadaf
authors.initials: S
authors.lastname: Javed
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Kumar
authors.forename: Juhi
authors.initials: J
authors.lastname: Tomar
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D001804:Blood Transfusion, Autologous / Q000295:instrumentation* / Q000379:methods*; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D017558:Elective Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis / Q000378:metabolism; D006801:Humans; D008297:Male; D057725:Operative Blood Salvage / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D006454:Hemoglobins