Timing Of Drainage Tube Removal After Simultaneous Hospital Staged Bilateral Total Knee Arthroplasty Stage Ⅱ

OBJECTIVE:To study the effects of different extubation times on amount of blood loss,knee HSS scores,VAS scores,first time out of bed activity and postoperative complications after simultaneous hospital staging of bilateral total knee arthroplasty II,and then investigate the optimal timing of drainage tube removal after staged bilateral total knee arthroplasty II,for the purpose of providing a reference for clinical work.METHODS:A total of 99 patients with bilateral knee osteoarthritis,13 males and 86 females,aged 53 to 85 years,who underwent bilateral total knee arthroplasty in the same treatment group managed in the Department of Joint II of Zhengzhou Orthopaedi Hospital between November 2020 and November 2021 were retrospectively analyzed.Three groups were divided according to the time of drainage tube removal in the second stage: 30 cases in group A: drainage tubes were removed within 18 hours after surgery;37 cases in group B: drainage tubes were removed from 18 to 24 hours after surgery;32 cases in group C: drainage tubes were removed from 24 to 30 hours after surgery.Preoperative basic data(gender,age,height,weight,body mass index,co-morbidities,duration of disease),interval between two surgical procedures,surgical side of the second-stage surgery,anesthesia,operative time,preoperative hemoglobin,erythrocyte count and platelet count,postoperative day 3 erythrocyte count,second-stage surgical drainage,intraoperative blood loss and blood transfusion,postoperative day 2,4 and 8 Hospital for Special Surgery score,pain visual analog score,first time out of bed activity,and postoperative complications were collected from each group of patients,and the obtained data were statistically analyzed.RESULTS:1.The differences in total postoperative blood loss and intraoperative bleeding between the three groups of patients in the second stage were not statistically significant(P>0.05);postoperative drainage in group A(205.67 ± 32.45)ml was less than that in group B(270.27 ± 26.82)ml and group C(284.06 ±25.64)ml,and the differences were statistically significant(P<0.05);postoperative occult blood loss in group A(424.98±100.21)ml were more than those in group B(340.47±102.90)ml and group C(335.56±100.18)ml,and the difference was statistically significant(P<0.05).2.The knee HSS scores increased gradually on postoperative days 2,4 and 8 in the three groups of patients,and the difference was statistically significant(P<0.05);the knee HSS scores of patients in group A were lower than those in groups B and C on postoperative day 2 and 4,and the difference was statistically significant(P<0.05);the knee HSS scores of patients in group B were higher than those in groups A and C on postoperative day 8,and the difference was statistically significant(P<0.05).3.The knee VAS scores decreased gradually on postoperative days 2,4 and 8 in the three groups of patients,and the difference was statistically significant(P<0.05);the knee VAS scores of patients in group A were higher than those in group B on postoperative day 2,and the difference was statistically significant(P<0.05);the knee VAS scores of patients in group A were higher than those in groups B and C on postoperative day 4 and 8,and the difference was statistically significant(P<0.05).4.The first time out of bed activity in groups A and B was(23.90±1.81)h and(24.38±1.88)h,which was less than that in group C(30.25±1.97)h,the difference was statistically significant(P<0.05).5.Three patients in group A had more oozing at the drainage port within 1-2 days after extubation and two had hematoma formation in the incision after surgery,but none of them had delayed incision healing;two patients in group C had postoperative redness,swelling and heat around the incision,but none of them had knee infection after active treatment.CONCLUSION:Under the condition of ensuring the patency of the drainage tube,the removal of the drainage tube 18 to 24 hours after the second stage of bilateral total knee arthroplasty in the same hospitalization can achieve the purpose of adequate drainage without increasing the postoperative pain and postoperative complications in the short term,while allowing the patient to get out of bed relatively early,which helps the patient to recover the knee function in the early postoperative period and improves the clinical outcome.Therefore,it is more appropriate to remove the tube 18 to 24 hours after surgery.