Non-drainage Offers Faster Proprioceptive and Functional Recovery, and More Clinical Benefits for Patients following Primary Total Knee Arthroplasty Compared to Drainage

Abstract

Background Although a non-drainage procedure following total knee arthroplasty (TKA) is becoming more acceptable in enhanced recovery after surgery, postoperative drainage is still commonly used in TKA surgeries. This study aimed to compare the non-drainage to the drainage during the early postoperative stage regarding proprioceptive and functional recovery, and postoperative outcomes of TKA patients.

Material and Methods A prospective, single-blind, randomized, controlled trial was carried out on 91 TKA patients, who were randomly allocated into the non-drainage group (NDG) or the drainage group (DG). Patients were evaluated regarding knee proprioception, functional outcomes, pain intensity, range of motion, knee circumference, and anesthetic consumption. Outcomes were assessed at the time of charge, at postoperative 7th day, and at postoperative 3rd month.

Results There were no differences between groups at baseline (p > 0.05). During the inpatient period, the NDG experienced superior pain relief (p < 0.05), had a higher Hospital for Special Surgery knee score (p = 0.001), demanded lower assistance from a sitting position to a standing position (p = 0.001) and walking for 4.5 m (p = 0.034), and performed the Timed Up and Go test in a shorter duration (p = 0.016) compared to the DG. The NDG gained the actively straight leg raise earlier (p = 0.009), needed lower anesthetic consumption (p < 0.05), and showed improved proprioception (p < 0.05) compared to the DG during the inpatient period.

Conclusions Our findings support that a non-drainage procedure would be a better option to provide a faster proprioceptive and functional recovery, and beneficial results for patients following TKA. Therefore, the non-drainage procedure should be the first choice in TKA surgery rather than drainage.

Zusammenfassung

Hintergrund Obwohl ein Verfahren ohne Drainage nach Knietotalendoprothetik (TKA) für eine verbesserte Genesung nach der Operation zunehmend akzeptabler wird, wird bei TKA-Operationen immer noch häufig eine postoperative Drainage verwendet. Diese Studie zielte darauf ab, die Nicht-Drainage mit der Drainage während der frühen postoperativen Phase in Bezug auf die propriozeptive und funktionelle Erholung und die postoperativen Ergebnisse von TKA-Patienten zu vergleichen.

Material und Methoden Eine prospektive, einfach verblindete, randomisierte, kontrollierte Studie wurde an 91 TKA-Patienten durchgeführt, die nach dem Zufallsprinzip in die Nicht-Drainage-Gruppe (NDG) oder die Drainage-Gruppe (DG) eingeteilt wurden. Die Patienten wurden hinsichtlich Kniepropriozeption, funktionellen Ergebnissen, Schmerzintensität, Bewegungsumfang, Knieumfang, Anästhesiemittelverbrauch bewertet. Die Ergebnisse wurden bei der Krankenhauseinweisung, am postoperativen 7. Tag und im postoperativen 3. Monat bewertet.

Ergebnisse Zu Studienbeginn gab es keine Unterschiede zwischen den Gruppen (p > 0,05). Während der stationären Phase erlebte NDG eine überlegene Schmerzlinderung (p < 0,05), hatte einen höheren HSS-Knie-Score (HSS: Hospital for Special Surgery; p = 0,001), benötigte weniger Unterstützung beim Aufstehen (p = 0,001) und beim Gehen für 4,5 m (p = 0,034) und führten im Vergleich zur DG-Gruppe einen Time-up-and-Go-Test in einer kürzeren Dauer (p = 0,016) durch. Die NDG erreichte das aktive Anheben des gestreckten Beins früher (p = 0,009), benötigte einen geringeren Anästhetikumverbrauch (p < 0,05) und zeigte während der stationären Phase eine verbesserte Propriozeption (p < 0,05) im Vergleich zur DG.

Schlussfolgerung Unsere Ergebnisse unterstützen, dass ein Verfahren ohne Drainage eine bessere Option wäre, um eine schnellere propriozeptive und funktionelle Erholung und vorteilhafte Ergebnisse für Patienten nach TKA zu erzielen. Daher sollte das Verfahren ohne Drainage die erste Wahl bei der TKA-Operation sein und nicht die Drainage.

Keywords

proprioception - functional outcomes - drainage - non-drainage - total knee arthroplasty

Schlüsselwörter

Propriozeption - funktionelle Ergebnisse - Drainage - Non-Drainage - Knietotalendoprothetik

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