Download PDF
Zentralbl Chir 2002; 127(10): 886-889
DOI: 10.1055/s-2002-35135
Originalarbeiten und Übersichten

© Georg Thieme Verlag Stuttgart · New York

Einfluss des Drainagesoges auf den postoperativen Verlauf nach Knieendoprothesen-Implantation

The Influence of the Drain Suction in Knee ArthroplastyChristine Seyfert1 , Katrin Schulz1 , Géza Pap2
  • 1Klinik für Orthopädie der KMG Kliniken AG, Kyritz
  • 2Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Orthopädische Universitätsklinik
Further Information

Publication History

Publication Date:
29 October 2002 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung: In einer prospektiven randomisierten klinischen Studie sollte der Einfluss des Drainagesoges auf den postoperativen Blutverlust und den Verlauf nach Implantation von Knieendoprothesen untersucht werden.
Patienten und Methode: 116 Patienten wurden mit einer Knie-TEP einseitig versorgt. Das durchschnittliche Alter betrug 71,2 Jahre. Die Operation erfolgte mehrheitlich ohne Blutleere. Alle Patienten erhielten jeweils 2 Wunddrainagen, 57 Patienten mit Sog und 59 Patienten ohne Sog. Es wurden der postoperative Blutverlust sowie klinische und paraklinische Verlaufsparameter erfasst.
Ergebnis: Der perioperative Blutverlust erreichte im Durchschnitt 338 ml. Der postoperative Blutverlust betrug in der Gruppe ohne Sog 436 ml und in der Gruppe mit Sog 528 ml. Hinsichtlich der Hämoglobinwerte am 1. und 7. postoperativen Tag, der Drainagefördermenge 12, 24, 36 und 48 Stunden postoperativ und der Wundheilung wurden keine signifikanten Unterschiede festgestellt. Sechs Patienten in der Gruppe ohne Sog und 5 Patienten in der Gruppe mit Sog mussten Blutkonserven erhalten.
Diskussion: Die Anlage eines Soges auf das Drainagesystem hatte keinen signifikanten Einfluss auf den postoperativen Blutverlust und den Verlauf nach Knieendoprothesenimplantation. In 9 von 10 Fällen wurde kein Fremdblut benötigt.

Abstract

Problem: In a prospective randomised clinical study, we investigated the impact of drain-suction on the post-operative blood loss and on both clinical and laboratory parameters after knee replacement operations.
Patients and Method: In this study, 116 patients with unilateral implantation of knee replacements were evaluated. The patients' average age was 71.2 years. The operation was carried out mostly without tourniquet application. All patients received two wound drains, 57 with and 59 without suction. The postoperative blood loss as well as clinical and laboratory parameters were assessed.
Results: The average peri-operative blood loss amounted to 338 ml. The post-operative blood loss in the group without drain suction was 436 ml and 528 ml in the group with suction. No significant differences could be found concerning the hemoglobin values pre-operatively and on the first and seventh post-operative day, the drainage quantity 12, 24, 36, and 48 hours post-operatively, the wound healing and the CRP. Six patients in the group without and five patients in the group with drain-suction had to receive blood transfusions.
Discussion: The application of suction on the drainage system had no significant impact on the post-operative blood loss and the postoperative course. In nine out of ten cases no homologous blood was needed.

Schlüsselwörter

Knieendoprothetik - Drainagesog - Retransfusion - Blutverlust - Blutleere

Key words

Knee replacement - drain suction - retransfusion - blood loss - ischemia

Literatur

  • 1 Adalberth G, Bystrom S, Kolstad K, Mallmin H, Milbrink J. Postoperative drainage of knee arthroplasty is not necessary; a randomized study of 90 patients.  Acta Orthop Scand. 1998;  69 475-478
    CrossrefPubMedGoogle Scholar
  • 2 Audet A M, Andrezejewski C, Popovsky M A. Red blood cell transfusion practices in patients undergoing orthopedic surgery: a multi-institutional analysis.  Orthopedics. 1998;  21 851-858
    PubMedGoogle Scholar
  • 3 Azuma T, Takahashi S, Kawamura A. Preoperative autologous blood donation in hip surgeries.  Transfus Sci. 2000;  23 177-181
    CrossrefPubMedGoogle Scholar
  • 4 Bae H, Westrich G H, Sculco T P, Salvati E A, Reich L M. The effect of preoperative donation of autologous blood on deep-vein thrombosis after total hip arthroplasty.  J Bone Joint Surg Br. 2001;  83 676-679
    CrossrefPubMedGoogle Scholar
  • 5 Becker D. Die „Robinson-Drainage” als neues Prinzip der Wunddrainage in der Unfallchirurgie.  Unfallheilkunde. 1981;  84 413-417
    PubMedGoogle Scholar
  • 6 Beer K J, Lombardi A V, Mallory T H, Vaughn B K. The efficacy of suction drains after routine total joint arthroplasty.  J Bone Joint Surg Am. 1991;  73 584-587
    PubMedGoogle Scholar
  • 7 Benoni G, Fredin H. Low- or high-vacuum drains in hip arthroplasty? A randomized study of 73 patients.  Acta Orthop Scand. 1997;  68 133-137
    CrossrefPubMedGoogle Scholar
  • 8 Bierbaum B E, Callaghan J J, Galante J O, Rubash H E, Tooms R E, Welch R B. An analysis of blood management in patients having a total hip or knee arthroplasty.  Comment in: J Bone Joint Surg Am. 2000;  82 900-901
    PubMedGoogle Scholar
  • 9 Billote D B, Glisson S N, Green D, Wixson R L. Efficacy of preoperative autologous blood donation: analysis of blood loss and transfusion practice in total hip replacement.  J Clin Anesth. 2000;  12 537-542
    CrossrefPubMedGoogle Scholar
  • 10 Breakwell L M, Getty C J, Dobson P. The efficacy of autologous blood transfusion in bilateral total knee arthroplasty.  Knee. 2000;  7 145-147
    CrossrefPubMedGoogle Scholar
  • 11 Browett J P, Gibbs A N, Copeland S A, Deliss L J. The use of suction drainage in the operation of meniscectomy.  J Bone Joint Surg Br. 1978;  60 516-519
    PubMedGoogle Scholar
  • 12 Burkart B D, Bourne R B, Rorabeck C H, Kirk P G, Nott L. The efficacy of tourniquet release in blood conservation after total knee arthroplasty.  Clin Orthop. 1994;  299 147-152
    PubMedGoogle Scholar
  • 13 Chandratreya A, Giannikas K, Livesley P. To drain or not drain: literature versus practice.  J R Coll Surg Edinb. 1998;  43 404-406
    PubMedGoogle Scholar
  • 14 Charrois O, Kahwaji A, Vastel L, Rosencher N, Courpied J P. Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis.  Int Orthop. 2001;  25 22-24
    CrossrefPubMedGoogle Scholar
  • 15 Churchill W H, Chapman R H, Rutherford C J, Poss R, Wallace E L, Surgenor D M. Blood product utilization in hip and knee arthroplasty: effect of gender and autologous blood on transfusion practice.  Vox Sang. 1994;  66 182-187
    PubMedGoogle Scholar
  • 16 Cobb J P. Why use drains?.  J Bone Joint Surg Br. 1990;  72 993-995
    PubMedGoogle Scholar
  • 17 Crevoisier X M, Reber P, Noesberger B. Is suction drainage necessary after total joint arthroplasty? A prospective study.  Arch Orthop Trauma Surg. 1998;  117 121-124
    CrossrefPubMedGoogle Scholar
  • 18 Dalen T, Skak S, Thorsen K, Fredin H. The efficacy and safety of blood reinfusion in avoiding homologous transfusion after total knee arthroplasty.  Am J Knee Surg. 1996;  9 117-120
    PubMedGoogle Scholar
  • 19 Dalen T, Brostrom L A, Engstrom K G. Autotransfusion after total knee arthroplasty. Effects on blood cells, plasma chemistry, and whole blood rheology.  J Arthroplasty. 1979;  12 517-525
    PubMedGoogle Scholar
  • 20 Diaz-Espallardo C, Moral-Carcia V. Cost-effectiveness analysis of an autotransfusion program in primary knee and hip replacement surgery.  Rev Esp Anestesiol Reanim. 1999;  46 396-403
    PubMedGoogle Scholar
  • 21 Feagan B G, Wong C J, Lau C Y, Wheeler S L, Sue-A-Quan G, Kirkley A. Transfusion practice in elective orthopaedic surgery.  Transfus Med. 2001;  11 87-95
    CrossrefPubMedGoogle Scholar
  • 22 Gainor J W. Transfusion in unilateral total knee arthroplasty.  Orthopedics. 2000;  23 473-474
    PubMedGoogle Scholar
  • 23 Gerngroß H, Engler V. Schwerkraft - kontra Saugdrainage.  Unfallchirurg. 1989;  92 37-42
    PubMedGoogle Scholar
  • 24 Gerngroß H, Marquardt K J. Welcher Sog ist für die Ableitung von Wundsekret der optimale?.  Chirurg. 1992;  63 447-453
    PubMedGoogle Scholar
  • 25 Gerngroß H, Willy C, Walter W M. Experimentelle und klinische Untersuchungen zur Verwendung einer dünnlumigen Polyurethanschwerkraftdrainage in der Unfallchirurgie.  Unfallchirurg. 1992;  95 21-30
    PubMedGoogle Scholar
  • 26 Grosvenor D, Goyal V, Goodman S. Efficacy of postoperative blood salvage following total hip arthroplasty in patients with and without deposited autologous units. Comment in: J Bone Joint Surg Am 2001; 83A (6): 953-954. UI:21300457. J Bone Joint Surg Am 2000; 82A (7): 951-957
    Google Scholar
  • 27 Hadden W A, McFarlane A G. A comparative study of closed wound suction drainage vs. no drainage in total hip arthroplasty.  J Arthroplasty. 1990;  5 21-24
    PubMedGoogle Scholar
  • 28 Hallstrom B R, Steele J F. Postoperative course after total hip arthroplasty: wound drainage versus no drainage.  Orthopp Rev. 1992;  21 847-851
    PubMedGoogle Scholar
  • 29 Heddle N M, Brox W T, Klama L N, Dickson L L, Levine M N. A randomized trial on the efficacy of an autologous blood drainage and transfusion device in patients undergoing elective knee arthroplasty. Comment in: Transfusion 1993; 33 (7): 622-623, Transfusion 1992; 32 (8): 742-746
    Google Scholar
  • 30 Jarolem K L, Scott D F, Jaffe W L, Stein K S, Jaffe F F, Atik T. A comparison of blood loss and transfusion requirements in total knee arthroplasty with and without arterial tourniquet.  Am J Orthop. 1995;  24 906-909
    PubMedGoogle Scholar
  • 31 Jensen C M, Pilegaard R, Hviid K, Nielsen J D, Nielsen H J. Quality of reinfused drainage blood after total knee arthroplasty.  J Arthroplasty. 1999;  14 312-318
    CrossrefPubMedGoogle Scholar
  • 32 Jorn L P, Lindstrand A, Toksvig-Larsen S. Tourniquet release for hemostasis increases bleeding. A randomized study of 77 knee replacements.  Acta Ortphop Scand. 1999;  70 265-267
    PubMedGoogle Scholar
  • 33 Juelsgaard P, Larsen U T, Sorensen J V, Madsen F, Soballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion.  Reg Anesth Pain Med. 2001;  26 105-110
    CrossrefPubMedGoogle Scholar
  • 34 Keating E M, Meding J B, Faris P M, Ritter M A. Predictors of transfusion risk in elective knee surgery.  Clin Orthop. 1998;  357 50-59
    PubMedGoogle Scholar
  • 35 Kirschner P, Römer H, Werner H P. Komplikationen der Redon-Drainage nach Hüftgelenksersatzoperationen - eine Analyse der Ursachen.  Unfallchirurgie. 1989;  15 24-31
    PubMedGoogle Scholar
  • 36 Labek G, Bohler N. Blutverbrauch bei Hüfttotalendoprothesenoperationen in Abhängigkeit von Redondrainage und Druckverband.  Z Orthop Ihre Grenzgeb. 1998;  136 433-438
    PubMedGoogle Scholar
  • 37 Lang G J, Richardson M, Bosse M J, Greene K, Meyer R A, Sims S H, Kellan J K. Efficacy of surgical wound drainage in orthopedic trauma patients: a randomized prospective trial.  J Orthop Trauma. 1998;  12 348-350
    CrossrefPubMedGoogle Scholar
  • 38 Lotke P A, Barth P, Garino J P, Cook E F. Predonated autologous blood transfusions after total knee arthroplasty: immediate versus delayed administration.  J Arthoplasty. 1999;  14 647-650
    PubMedGoogle Scholar
  • 39 Miguel A, Chalmers G B, Chalmers J J. Flow parameters associated with hydrodynamic cell injury.  Biotechnology and Bioengineering. 1994;  44 1098
    PubMedGoogle Scholar
  • 40 Niskanen R O, Korkala O L, Haapala J, Kuokkanen H O, Kaukonen J P, Salo S A. Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study.  J Arthroplasty. 2000;  15 567-569
    CrossrefPubMedGoogle Scholar
  • 41 Oberhammer E. Geschlossene abdominelle Wunddrainage nach Robinson.  Zentralbl Chir. 1982;  107 964-968
    PubMedGoogle Scholar
  • 42 Ovadia D, Luger E, Bickels J, Menachem A, Dekel S. Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomised study.  J Arthroplasty. 1997;  12 317-321
    CrossrefPubMedGoogle Scholar
  • 43 Peter V K, Radford M, Matthews M G. Re-transfusion of autologous blood from wound drains: the means for reducing transfusion requirements in total knee arthroplasty.  Knee. 2001;  8 321-342
    CrossrefPubMedGoogle Scholar
  • 44 Redon H, Jost G, Torques Y. La fermature sous depression des paies étendues.  Med Acad Chir. 1954;  80 394-396
    PubMedGoogle Scholar
  • 45 Reilly T J, Gradisar I A, Pakan W, Reilly M. The use of postoperative suction drainage in total knee arthroplasty.  Clin Orthop. 1986;  208 238-242
    PubMedGoogle Scholar
  • 46 Ritter M A, Keating E M, Faris P M. Closed wound drainage in total hip or total knee replacement.  J Bone Joint Surg Am. 1994;  76 35-38
    PubMedGoogle Scholar
  • 47 Robinson J O, Brown A A. A new closed drainage system.  Br J Surg. 1980;  67 299-300
    PubMedGoogle Scholar
  • 48 Roberts M, Ahya R, Greaves M, Maffulli N. A one-centre prospective audit of peri- and postoperative blood loss and transfusion practice in patients undergoing hip or knee replacement surgery.  Ann R Coll Surg Engl. 2000;  82 44-48
    PubMedGoogle Scholar
  • 49 Rollo V J, Hozack W J, Rothmann R H, Chao W, Eng K O. Prospective randomized evaluation of blood salvage techniques for primary total hip arthroplasty.  J Arthroplasty. 1995;  10 532-539
    CrossrefPubMedGoogle Scholar
  • 50 Sehat K R, Evans R, Newman J H. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account.  Knee. 2000;  7 151-155
    CrossrefPubMedGoogle Scholar
  • 51 Steinitz D, Harvey E J, Leighton R K, Petrie D P. Is homologous blood transfusion a risk factor for infection after hip replacement?.  Can J Surg. 2001;  44 355-358
    PubMedGoogle Scholar
  • 52 Tetro A M, Rudan J F. The effects of a pneumative tourniquet on blood loss in total knee arthroplasty.  Can J Surg. 2001;  44 33-38
    PubMedGoogle Scholar
  • 53 Toy P T, Kaplan E B, McVay P A, Lee S J, Strauss R G, Stehling L C. Blood loss and replacement in total hip arthroplasty: a multicenter study.  Transfusion. 1992;  32 63-67
    CrossrefPubMedGoogle Scholar
  • 54 Widmann J, Isacson J. Surgical haemostasis after tourniquet release does not reduce blood loss in knee replacement. A prospective randomized study of 81 patients.  Acta Orthop Scand. 1999;  70 268-270
    PubMedGoogle Scholar
  • 55 Willet K M, Simmons C D, Benthley G. The effect of suction drains after total hip replacement.  J Bone Joint Surg Br. 1988;  70 607-610
    PubMedGoogle Scholar
  • 56 Wirbel R, Mutschler W. Die postoperative Wunddrainage in der Chirurgie des Bewegungsapparates.  Operat Orthop Traumatol. 2001;  4 312-318
    PubMedGoogle Scholar

Dr. med. Christine Seyfert

Klinik für Orthopädie der KMG Kliniken AG

Perleberger Str. 31 a

16866 Kyritz

      >