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A Prospective Randomized Controlled Trial of the Use of Drains in Total Hip Arthroplasty

A Prospective Randomized Controlled Trial of the Use of Drains in Total Hip Arthroplasty. Presented By : Dr. Abdulrahman Algarni. Introduction.

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A Prospective Randomized Controlled Trial of the Use of Drains in Total Hip Arthroplasty

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  1. A Prospective Randomized Controlled Trial of the Use of Drains in Total Hip Arthroplasty Presented By : Dr. AbdulrahmanAlgarni

  2. Introduction • Drains are used commonly in orthopedic surgery particularly arthroplasty principally to reduce the formation of hematoma which increase tension and reduce perfusion of tissues as well as providing medium for infection. • Literature is conflicting.

  3. Continue : • Recent Meta-Analysis suggested that the only proven benefit is a reduced need for the change of dressings. • The aim is to evaluate the routine use of drains in T.H.A. with follow-up of 3 years.

  4. Patients and Methods • 552 patients, at two hospitals, Six consultants . • Sep. 1997 and Dec. 2000. • Revisions or preoperative skin pathology patients are excluded. • Age, gender, BMI, Primary hip disorder past medical history, Hb, HHS and concomitant medical problems were obtained.

  5. Continue : • Arthroplasty research nurse, who was blinded, collected the data. • LMWH (Deltaparin 5000IU), Elastic stockings IV Cefuroxime, Elite Plus or Charnley prostheses, Anterolateral approach. • At the end of procedure, they were randomised by opaque – numbered envelops to either no drain or a 3 mm Redivac drain which was removed at 24 hrs.

  6. Continue : • Postop. Hb at 24 hrs. • If Hb < 8 g/dl or < 10 g/dl and symptomatic 2 U PRBC allogenic were transfused. • Follow up at 6, 18 and 36 months : Radiographs and HHS obtained. • P value < 0.05 was considered significant.

  7. Results • Of the 552, 25 had B/L THA. • In the drained group : 9% (25 of 282) with incomplete follow-up Vs. 8% (23 of 295) in the undrained group.

  8. Discussion • The only clear benefit is reduced need for change of dressing. • Most studies which identify an increased incidence of hematoma, swelling and bruising if a drain is not used fail to report any serious adverse outcomes. • Most studies report < 2% deep infection rate.

  9. Continue : • Divergence of opinion about rates of transfusion and the use of drains. • No difference in other outcome measures of revision, DVT-PE, Postop, Hb, HHS and length of hospital stay.

  10. Conclusion • Drains provide no advantage to patients undergoing THA, represent an additional cost and expose the patient to potentially adverse effects such as blood transfusion. • We would recommend discontinuing the routine use of drains at uncomplicated T.H.A.

  11. THANK YOU

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