Optimal release timing of temporary drain clamping after total knee arthroplasty

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RESEARCH ARTICLE

Open Access

Optimal release timing of temporary drain clamping after total knee arthroplasty Yoon Sang Jeon, Jun Sung Park and Myung Ku Kim*

Abstract Background: Bleeding control is critical after total knee arthroplasty (TKA). The purpose of this study was to evaluate the optimal time to release the clamped drain after TKA. Methods: We performed unilateral TKA in 120 patients using three methods of drainage. Group A (N = 40) had a 3-hour clamp applied, and group B (N = 40) had a 4-hour clamp applied. Group C (N = 40) underwent conventional negative drainage. We evaluated the drainage volume, as well as the hemodynamic markers, transfusion volume, visual analog scale (VAS) scores, and range of motion (ROM). Results: The drained blood volume in groups A and B was significantly less than that in group C. No significant difference was found between groups A and B. The level of hemoglobin in group A was significantly higher than that in group C at 2 days after surgery. The ROM of groups A and C was larger than that of group B at 5 days after surgery. Furthermore, the VAS scores of groups A and C were significantly lower than those of group B at both 2 and 5 days after surgery. Conclusions: The temporary drain clamping method after TKA significantly reduced the volume of bleeding and blood transfusion. The 3-h clamping method reduced the drained volume as effectively as the 4-hour clamping method and resulted in less acute phase pain and more rapid recovery of ROM than the 4-hour clamping method. In conclusion, we recommend 3-h clamping after TKA as the optimal release time to reduce blood loss and acute phase pain. Keywords: Total knee replacement, Bleeding, Clamping

Background Total knee arthroplasty (TKA) presents a high risk of significant bleeding and blood transfusion. It is costly, it carries a high risk of disease transmission, and it warrants extended hospitalization [1, 2]. To reduce and control the bleeding, various methods have been suggested, including tranexamic acid [3, 4], temporary drain clamping [5–7], and the use of a fibrin agent [8]. Controversy concerning the preferred drainage method after TKA persists. Although drainage helps prevent hematoma and is effective in reducing pain and edema [9–11], it carries a risk of increasing bleeding when removing the tamponade and thus providing a subsequent route of infection. Temporary drain clamping is one of several methods devised to reduce bleeding after surgery. The drain is * Correspondence: [email protected] Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3-Ga Sinheung-dong, Jung-gu, Incheon 400-711, South Korea

clamped for several hours after surgery to form a tamponade before opening. This method is considered effective in reducing bleeding [12]. Prior studies have examined many methods, such as the intermittent method [13–15] and the specific hour-drain clamping after surgery (e.g., 1 [16], 2 [17], 4 [18], 12 [19], and 24 h [20]). However, the most suitable method has not yet been establish