Tourniquet and closed-suction drains in total knee arthroplasty. No beneficial effects on bleeding management and knee function at a higher cost

Background: Blood loss is a major concern in total knee arthroplasty (TKA) along with postoperative knee function. The present study explores the impact of tourniquet T) and closed-suction drains (D) on the separameters in TKA. Materials and methods: A prospective study was conducted on 111 patients admitted for TKA. Subjects were divided into three groups: 36 in group T+D+, 42 in T-D+ and 33 in T-D-(where T+: prolongedtourniquet use, T-: cementation-only tourniquet, D+: closed-suction drain use, and D-: no drain). Results: No statistically significant differences were observed among the three groups(T+ D+, T-D+ and T-D-) for total blood loss, hemoglobin levels over the first six postoperative weeks and blood transfusion rate. Intraoperative bleeding was significantly reduced in T+ subjects compared to T-subjects( 100 +/- 88 mL vs. 279 +/- 235 mL respectively, P < 0.001), yet length of surgery was unaffected. Hidden blood loss was lower in D+ subjects compared to D-subjects (1161 +/- 554 mL vs. 1667 +/- 554 mL respectively, P < 0.001), but was offset by the blood loss in the drains. Early postoperative range of motion (ROM) was superior in group T-D-compared to group T+ D+. Nevertheless, postoperative week 6 ROM was similar between the 3 groups as was patient-reported postoperative pain. A patient with a drain represents 35 min of extra nursing time and a total cost of $31.87 CAD. Conclusions: Whole-course tourniquet and closed-suction drain use in TKA do not yield beneficial results while increasing costs. Their use is therefore deemed unnecessary. (C) 2017 Elsevier Masson SAS. All rights reserved.