Meta-analysis Comparing Drainage And Nondrainage Following Primary Total Knee Arthroplasty

Objective: This meta-analysis was conducted to compare the clinicaloutcome of closed suction drainage with nondrainage following primarytotal knee arthroplasty (TKA) on the basis of the best available evidence.Materials and methods: Randomized controlled trils (RCTs) reportedbetween1950and December2013comparing primary TKA patientsmanaged with closed-suction drainage and those without a drain wereconsidered. The Review Mananger was used to analyse selected studies.When significant heterogeneity existed, subgroup analysis was carried out.Results: Sixteen RCTs involving1417knees (713knees in the drainagegroup and704in the nondrainage group) satisfied the inclusion criteria. Inclosed-suction drainage group, the incidence of soft tissue ecchymosis wassignificantly lower than in the nondrainage group. Subgroup analysisshowed even greater difference of the two groups in the setting ofsimultaneous bilateral TKA. However, results favoured the nondrainagegroup with respect to the total blood loss volume and blood transfusion rates. No significant difference has been demonstrated in the prevalence ofinfection, incidence of deep venous thrombosis (DVT), or postoperativerange of motion (ROM) between two groups.Conclusions: Current RCTs demonstrated that the use of closed suctiondrainage after primary TKA provides no benefit in terms of infection, DVT,and postoperative ROM when compared with nondrainage. Besides, itincreases perioperative total blood loss volume and elevates the risk ofhomologous blood transfusion. The only proven advantage of drainage is adecreased incidence of blood leakage from the wound, especially whensimultaneous bilateral TKA is performed.