Routine use of Closed Suction Drainage may not be beneficial in Revision Total Hip Arthroplasty

Closed suction drainage (CSD) is often used in orthopedic surgery to reduce postoperative hematoma formation, wound complications, and pain, resulting in the promotion of wound healing and rehabilitation. Evidence supporting the clinical benefits of CSD in revision THA is insufficient, and these studies included revision THAs due to post-infection or periprosthetic fractures, which could influence infection rates and total blood loss. Therefore Yaichiro Okuzu et al conducted a retrospective study aimed to investigate the benefits of CSD in revision THA.

The study was conducted at Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine ,Shogoin-Kawahara-cho, Sakyo-ku , Kyoto, Japan. It has been published in ‘Indian Journal of Orthopaedics.’

The authors reviewed 107 hips of patients who underwent revision THA, excluding cases of fracture and infection. They compared perioperative blood test results, calculated total blood loss (TBL), and postoperative complications, including allogenic blood transfusion (ABT), wound complications, and deep venous thrombosis (DVT), between the groups with and without CSD. Propensity score matching was conducted to balance patients’ demographics and surgical factors.

Key findings of the study were:

• ABT, wound complications, and DVT were observed in 10.3% ( n = 11), 5.6% (six), and 5.6% (six) of patients, respectively.

• There were no significant differences in ABT, calculated TBL, wound complications, and DVT between all patients and propensity score-matched patients with or without CSD.

• The calculated TBL was approximately 1200 mL and showed no significant difference between the two groups in the matched cohort ( p = 0.40) but tended to have a greater volume in the drain group than in the non-drain group.

The authors concluded that – “CSD in revision THA, mainly due to aseptic loosening, may not have any benefit. The routine use of CSD in revision THA may not be useful in clinical practice.”

Further reading:

Closed Suction Drainage May Not be Beneficial in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Study Yaichiro Okuzu, Koji Goto et al Indian Journal of Orthopaedics (2023) 57:1041–1048 https://doi.org/10.1007/s43465-023-00901-x