title: Autologous re-transfusion drain compared with no drain in total knee arthroplasty: a randomised controlled trial.
abstract: BACKGROUND
  Post-operative anaemia following total knee arthroplasty is reported to impede functional mobility in the early period following surgery, whereas allogeneic blood transfusions, used to correct low post-operative haemoglobin levels, have concomitant disadvantages. The use of a post-operative autologous blood re-transfusion drainage system as well as no drainage system following total knee arthroplasty have been shown to reduce peri-operative blood loss and allogeneic blood transfusions, compared to the regularly used closed-suction drains. No randomised studies have been performed, to the best of our knowledge, that indicate the superiority of either method.
  
  
  METHODS
  An open, randomised controlled study was conducted in 115 patients undergoing total knee arthroplasty who were randomly allocated to an autotransfusion drain or no drainage system. The primary end-point was haemoglobin level on the first post-operative day.
  
  
  RESULTS
  In the autotransfusion group 515 mL (0-1,500 mL) of drained blood was re-transfused within the first 6 hours after surgery. Haemoglobin levels on the first (11.6 vs 11.0 g/dL), second (11.0 vs 10.3 g/dL) and third (10.5 vs 9.8 g/dL) days after surgery were significantly higher in the autotransfusion group. Total peri-operative net blood loss (1,576 mL vs 1,837 mL; -P=0.03) and allogeneic transfusion rates (10.2% vs 19.6%; P=0.15) were lower in the autotransfusion group. There were no differences in pain scores, range of motion or adverse events during hospital stay and the first 3 months after surgery.
  
  
  CONCLUSIONS
  Compared with no drainage, the use of a post-operative autologous blood re-transfusion drainage system following total knee arthroplasty results in higher post-operative haemoglobin levels and less total blood loss.
authors.affiliation: Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: Wieger
authors.initials: W
authors.lastname: Horstmann
authors.affiliation: Isala Clinics, Zwolle, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Kuipers
authors.affiliation: Isala Clinics, Zwolle, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: Ohanis
authors.affiliation: Department of Quality and Safety, Amphia Hospital, Breda, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Slappendel
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Kollen
authors.affiliation: Isala Clinics, Zwolle, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Verheyen
mesh_terms: D000368:Aged; D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011182:Postoperative Care / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000150:complications; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins