Background: The use of closed-suction drainage systems after total
joint replacement is a common practice. The theoretical advantages for the use
of drains is a reduction in the occurrence of wound hematomas and infection.
The aim of this meta-analysis was to determine, on the basis of the evidence
from randomized controlled trials, the advantages and adverse effects of
Methods: All randomized trials, as far as we know, that compared
patients managed with closed-suction drainage systems and those managed
without a drain following elective hip and knee arthroplasty were considered.
The trials were identified with use of searches of the Cochrane Collaboration
with no restriction on languages or source. Two authors independently
extracted the data, and the methods of all identified trials were
Results: Eighteen studies involving 3495 patients with 3689 wounds
were included in the analysis. The pooled results indicated that there was no
significant difference between the wounds treated with a drain and those
treated without a drain with respect to the occurrence of wound infection
(relative risk, 0.73; 95% confidence interval, 0.47 to 1.14), wound hematoma
(relative risk, 1.73; 95% confidence interval, 0.74 to 4.07), or reoperations
for wound complications (relative risk, 0.52; 95% confidence interval, 0.13 to
1.99). A drained wound was associated with a significantly greater need for
transfusion (relative risk, 1.43; 95% confidence interval, 1.19 to 1.72).
Reinforcement of wound dressings was required more frequently in the group
managed without drains. No difference between the groups was seen with respect
to limb-swelling, venous thrombosis, or hospital stay.
Conclusions: Studies to date have indicated that closed suction
drainage increases the transfusion requirements after elective hip and knee
arthroplasty and has no major benefits. Further randomized trials with use of
larger numbers of patients with full reporting of outcomes are indicated
before the absence of any benefit, particularly for the outcome of wound
infection, can be proved.
Level of Evidence: Therapeutic study, Level I-2
(systematic review of Level-I randomized controlled trials [studies were
homogeneous]). See Instructions to Authors for a complete description of
levels of evidence.