JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES) ›› 2016, Vol. 54 ›› Issue (6): 43-49.doi: 10.6040/j.issn.1671-7554.0.2015.757

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Do we really need wound drainage in hip arthroplasty? A meta-analysis

XU Chuang1, QI Dachun1, LI Xianrang1, ZU Meng2, LI Jian1, LIU Mingting1   

  1. 1. Department of Bone and Joint Surgery;
    2. Department of Obstetrics and Gynecology, Affiliated Hospital of Binzhou Medical College, Binzhou 256600, Shandong, China
  • Received:2015-09-08 Online:2016-06-20 Published:2016-06-20

Abstract: Objective To explore the efficacy and safety of wound drainage in hip arthroplasty by meta-analysis. Methods The criteria for inclusion and exclusion were formulated. The following databases were searched, including PubMed, EBSCO, Cochrane Library, WanFang Database and China National Knowledge Infrastructure(CNKI)for studies published during Jan. 2000 and Aug. 2015, and then the randomized trials on hip arthroplasty with wound drainage system and without drainage system were compared. Meta-analysis were conducted with Review Manager 5.2. Results A total of 20 studies involving 2 270 participants(1 134 drains and 1 136 without drains)were included in our meta-analysis. There was no significant difference in the incidence of wound infections (RR=0.75, 95%CI: 0.49-1.14, P=0.18), wound hematomas(RR=0.98, 95%CI: 0.25-3.91, P=0.98), deep vein thrombosis (RR=2.56, 95%CI: 0.86-7.68, P=0.09), pulmonary embolism(RR=2.37, 95%CI: 0.35-15.94, P=0.38)or pain between the two groups. Our results demonstrated blood transfusion(RR=1.36, 95%CI: 1.18-1.58, P<0.001), transfusion unit(WMD=0.64, 95%CI: 0.21-1.07, P<0.05)and blood loss(WMD=277.80, 95%CI: 118.88-436.73, P<0.05)were more frequent in those who received drains. Conclusion The routine use of wound drainage for hip arthroplasty has no obvious advantages. However, there is a moderate possibility of selection bias and publication bias in this review. More samples and high-quality randomized trials are needed to increase the reliability of evidences.

Key words: Drainage, Safety, Hip arthroplasty, Effectiveness, Meta-analysis

CLC Number: 

  • R681.6
[1] Zhou X, Li J, Xiong Y, et al. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis[J]. Int Orthop, 2013, 37(11):2109-2118.
[2] Li N, Li P, Liu M, et al. Comparison between autologous blood transfusion drainage and no drainage/closed-suction drainage in primary total hip arthroplasty:a meta-analysis[J]. Arch Orthop Trauma Surg, 2014, 134(11):1623-1631.
[3] Crevoisier XM, Reber P, Noesberger B. Is suction drainage necessary after total joint arthroplasty?[J]. Arch Orthop Trauma Surg, 1998, 117(3):121-124.
[4] Garvin KL, Konigsberg BS. Infection following total knee arthroplasty[J]. J Bone Joint Surg Am, 2011, 93(12):1167-1175.
[5] Matar WY, Jafari SM, Restrepo C, et al. Preventing infection in total joint arthroplasty[J]. J Bone Joint Surg Am, 2010, 92(Supplement 2):36-46.
[6] Chen Z, Gao Y, Chen W, et al. Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials[J]. Eur J Orthop Surg Traumatol, 2014, 24(6):939-946.
[7] Niskanen RO, Korkala OL, Haapala J, et al. Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis:a prospective randomized study[J]. J Arthroplasty, 2000, 15(5):567-569.
[8] Ravikumar KJ, Alwan T, Fordyce MJF, et al. Drainage versus non-drainage in total hip arthroplasty. A prospective randomised study[J]. Hip Int, 2001, 11(1):49-54.
[9] Mengal B, Aebi J, Rodriguez A, et al. A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty[J]. Rev Chir Orthop Reparatrice Appar Mot, 2001, 87(1):29-39.
[10] Widman J, Jacobsson H, Larsson SA, et al. No effect of drains on the postoperative hematoma volume in hip replacement surgery:a randomized study using scintigraphy[J]. Acta Orthop Scand, 2002, 73(6):625-629.
[11] González DVA, Slullitel G, Vestri R, et al. No need for routine closed suction drainage in elective arthroplasty of the hip:a prospective randomized trial in 104 operations[J]. Acta Orthop Scand, 2004, 75(1):30-33.
[12] Johansson T, Engquist M, Pettersson LG, et al. Blood loss after total hip replacement:a prospective randomized study between wound compression and drainage[J]. J Arthroplasty, 2005, 20(8):967-971.
[13] Walmsley PJ, Kelly MB, Hill RMF, et al. A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty[J]. J Bone Joint Surg Br, 2005, 87(10):1397-1401.
[14] Matsuda K, Nakamura S, Wakimoto N, et al. Drainage does not increase anemia after cementless total hip arthroplasty[J]. Clin Orthop Relat Res, 2007, 458:101-105.
[15] Dora C, von Campe A, Mengiardi B, et al. Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations[J]. Arch Orthop Trauma Surg, 2007, 127(10):919-923.
[16] 杨东, 张伟, 孙水, 等. 初次全髋关节置换术后引流管应用的必要性探讨[J]. 山东医药, 2008, 48(18):88-89.
[17] 陈巧玲, 全小明. 全髋关节置换术后引流放置的对比研究[J]. 护士进修杂志, 2009, 24(4):295-296.
[18] Strahovnik A, Fokter SK, Kotnik M. Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty[J]. J Arthroplasty, 2010, 25(2):244-248.
[19] Cheung G, Carmont MR, Bing AJ, et al. No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients[J]. Acta Orthop Belg, 2010, 76(5):619-627.
[20] 孙建辉. 加压包扎与负压引流预防全髋关节置换术后失血量效果比较[J]. 实用医药杂志, 2010, 27(3):202-204.
[21] Kleinert K, Werner C, Mamisch-Saupe N, et al. 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[J]. Arch Orthop Trauma Surg, 2012, 132(1):131-136.
[22] von Roth P, Perka C, Dirschedl K, et al. Use of Redon drains in primary total hip arthroplasty has no clinically relevant benefits[J]. Orthopedics, 2012, 35(11):e1592-5.
[23] 陈科, 吕小华, 曾荣, 等. 初次髋关节置换后不放置引流管的安全性[J]. 中国组织工程研究, 2012, 16(35):6494-6497.
[24] Zeng W, Zhou K, Zhou Z, et al. Comparison between Drainage and Non-drainage after Total Hip Arthroplasty in Chinese Subjects[J]. Orthop Surg, 2014, 6(1):28-32.
[25] 鲁娟, 陈珍珍, 洪雪佩, 等. 全髋关节置换术切口不引流的临床应用及效果观察[J]. 中国现代医生, 2014, 52(33):124-126.
[26] Koyano G, Jinno T, Koga D, et al. Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty[J]. J Arthroplasty, 2015, 30(1):74-78.
[27] Snell S. On the suction-operation for cataract[J]. Br Med J, 1876, 1(802):595.
[28] Howe L. On the removal of hard cataract by suction[J]. Trans Am Ophthalmol Soc, 1893, 6:594.
[29] 翟生, 熊道海, 武忠炎. 切口闭合引流在髋关节置换术中作用的系统评价[J]. 现代中西医结合杂志, 2010, 19(16):1959-1962.
[30] Zhang Q, Guo W, Zhang Q, et al. Comparison between closed suction drainage and nondrainage in total knee arthroplasty:a meta-analysis[J]. J Arthroplasty, 2011, 26(8):1265-1272.
[31] Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties[J]. J Arthroplasty, 1998, 13(2):156-161.
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