Is It Safe to Perform Revision Hip Arthroplasty Without Suction Drains?

Hafiz Muhammad Umer; Hafiz Javaid Iqbal; Nisarg Shah; Harshil Vora; Aatif Mahmood; Tim Board

doi:10.7759/cureus.39682

Is It Safe to Perform Revision Hip Arthroplasty Without Suction Drains?

Cureus. 2023 May 30;15(5):e39682. doi: 10.7759/cureus.39682. eCollection 2023 May.

Authors

Hafiz Muhammad Umer¹, Hafiz Javaid Iqbal^{2

3}, Nisarg Shah³, Harshil Vora³, Aatif Mahmood², Tim Board³

Affiliations

¹ Trauma and Orthopedics, Stepping Hill Hospital, Manchester, GBR.
² Trauma and Orthopedics, Countess of Chester Hospital, Chester, GBR.
³ Trauma and Orthopedics, Wrightington Hospital, Wigan, GBR.

Abstract

Background There is a number of studies showing no significant benefit of using drains after primary hip arthroplasty. However, there is no consensus in the literature about the usage of drains in revision hip replacement. This study aims to assess the effect of drains in revision hip arthroplasty. Methods A retrospective analysis was performed of all consecutive revision hip replacement surgeries performed at our unit over a five-month period (November 2018 to March 2019). Case notes, laboratory investigations, and operative records were reviewed. The effects of drains on postoperative hemoglobin (Hb), transfusion rate, and complications were analyzed. Results Overall, 92 patients were analyzed who underwent revision hip replacement during the study period. There were 46 male and 46 female patients with a mean age of 72 years. Aseptic loosening was the most common indication for the revision (41 patients) followed by instability (21 patients), infection (11 patients), and periprosthetic fractures (eight patients). Seventy-two patients had no drains while suction drains were used in 20 patients. Both groups were similar regarding age, sex, and indications for revision surgery. There was a significantly higher drop in postoperative Hb in patients with drains than those without drains (33 g/L: 27 g/L, p=0.03). There were significantly more blood transfusions in patients with drains as compared to those without drains (15%: 8%, relative risk 1.8, and odds ratio 1.94). There was no difference in both groups with regard to returning to the theater. Discussion Use of suctions drains in revision hip surgery was associated with increased postoperative blood loss and increased requirement for postoperative blood transfusion. Revision hip surgery without routine usage of suction drains did not increase wound complications. Conclusion Revision surgery without routine usage of drains is safe and may decrease postoperative blood loss and the rate of transfusion.

Keywords: blood loss; drain; haematoma; prosthetic joint infection; revision hip arthroplasty; revision hip replacement; suction drains; transfusion rate.