title: Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach.
abstract: BACKGROUND
  Wondering if the use of drains allowing re-transfusion of shed blood as opposed to closed suction drains or no drains would improve quality of care to patients undergoing simple non-cemented primary total hip replacement (THR) using a direct anterior approach, a three-arm prospective randomized study was conducted.
  
  
  METHODS
  One hundred and twenty patients were prospectively randomized to receive no drain, closed suction drains or drains designed for re-transfusion of shed blood. Blood loss, VAS pain scores, thigh swelling, hematoma formation, number of dressings changed and hospital stay were compared and patients followed for 3 months.
  
  
  RESULTS
  Drains did not have any significance on postoperative haemoglobin and haematocrit levels or homologous blood transfusion rates. Patients receiving homologous blood transfusions had too small drain volumes to benefit from re-transfusion and patients, who get drained fluid re-transfused, were far away from being in need of homologous blood transfusion. Omitting drains resulted in more thigh swelling accompanied with a tendency of slightly more pain during the first postoperative day but without effect on clinical and radiological outcome at 3 months. Earlier dry operation sites resulting in simplified wound care and shorter hospital stay was encountered when no drain was used.
  
  
  CONCLUSIONS
  The possibility to re-transfuse drained blood was not an argument for using drains and, accepting more thigh swelling, we stop to use drains in simple non-cemented primary THR using the direct anterior approach.
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kleinert
authors.forename: Clément
authors.initials: C
authors.lastname: Werner
authors.forename: Nadja
authors.initials: N
authors.lastname: Mamisch-Saupe
authors.forename: Fabian
authors.initials: F
authors.lastname: Kalberer
authors.forename: Claudio
authors.initials: C
authors.lastname: Dora
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D013396:Suction / Q000379:methods; D016896:Treatment Outcome