Abstract
Drain use in total knee arthroplasty (TKA) remains controversial. Use has been associated
with increased complications, particularly postoperative transfusion, infection, increased
cost, and longer hospital stays. However, studies examining drain use were performed
before widespread adoption of tranexamic acid (TXA), which markedly reduces transfusion
without increasing venous thromboembolism events. We aim to investigate incidence
of postoperative transfusion and 90-day return to the operating room (ROR) for hemarthrosis
in TKA with use of drains and concomitant intravenous (IV) TXA. Primary TKAs from
a single institution were identified from August 2012 to December 2018. Inclusion
criteria were primary TKA, age 18 years and over where use of TXA, drains, anticoagulant,
and pre- and postsurgical hemoglobin (Hb) were documented during the patient's admission.
Primary outcomes were 90-day ROR specifically for hemarthrosis and rate of postoperative
transfusion. A total of 2,008 patients were included. Sixteen patients required ROR,
three of which were due to hemarthrosis. Drain output was statistically higher in
the ROR group (269.3 vs. 152.4 mL, p = 0.05). Five patients required transfusion within 14 days (0.25%). Patients requiring
transfusion had significantly lower presurgical Hb (10.2 g/dL, p = 0.01) and 24-hour postoperative Hb (7.7 g/dL, p < 0.001). Drain output between the transfusion and no transfusion groups varied significantly
(p = 0.03), with transfusion patients having higher postoperative day 1 drain output
of 362.6 mL and total drain output of 376.6 mL. In this series, postoperative drain
use with concomitant weight-based IV TXA is shown to be safe and efficacious. We observed
exceedingly low risk of postoperative transfusion compared with prior reports of drain
use alone as well as preserved low rate of hemarthrosis that has previously been positively
linked to drain use.
Keywords
primary total knee arthroplasty - closed suction drainage - tranexamic acid - total
knee arthroplasty complications
