International Orthopaedics (SICOT) (2014) 38:2651–2652 DOI 10.1007/s00264-014-2577-6
LETTER TO THE EDITOR
Comment on Quinn et al.: the use of postoperative suction drainage in total knee arthroplasty: a systematic review Jianzhong Hu & Lei Zeng & Hongbin Lu
Received: 5 October 2014 / Accepted: 20 October 2014 / Published online: 4 November 2014 # SICOT aisbl 2014
Dear editor, We read with great interest the article by Quinn et al. [1] entitled “The use of postoperative suction drainage in total knee arthroplasty: a systematic review” published online in July 2014 in International Orthopaedics. The authors performed a meta-analysis to compare no drainage and drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, and length of hospital stay and haemoglobin level following TKA. Overall, it is an interesting study. Nevertheless, we would like to communicate several queries to the authors. 1. The authors stated that “The random effect model was applied and the I 2 statistic described study heterogeneity” in the methods section. In their study, a fixed-effect model was still used for analysing the range of knee flexion (referring to Fig. 2 in Quinn’s article [1]). The weight of Adalberth’s study was up to 91.9 %. So it is necessary to discuss to what extent the results could be trusted. 2. The authors stated that six studies were included for analysis. After a quick research with the search algorithm “total OR knee arthroplasty OR replacement OR TKA OR TKR” AND “drainage OR drain”. Seven additional studies were found to meet the inclusion criteria [2–8]. This may have affected the final results. J. Hu : L. Zeng Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, People’s Republic of China H. Lu (*) Department of Sports Medicine, Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People’s Republic of China e-mail: [email protected]
3. In the results, both “range of motion” and “knee flexion” were used. The range of motion of knee includes knee flexion and knee extension. It is unreasonable to simply replace “range of motion” with “knee flexion”. 4. There was a slip of the pen in the results. The citation from 4 to 9 should be replaced with 9–14 in the results. 5. Several important measures, including infection, postoperative soft tissues ecchymosis, requirement for dressing reinforcement, deep venous thrombosis and requirement for homologous blood transfusion, were not analysed in the study. These might be limitations to this study. In conclusion, we do agree with the results of this metaanalysis by Quinn et al. Routine use of postoperative suction drains in primary total knee arthroplasty did not show improvements in terms of knee swelling or flexion, length of hospital stay or haemoglobin levels. Long-term follow up of individuals and larger multi-centre clinical RCTs are highly necessary to confirm the results.
References 1. Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J (2014) The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop. doi:10.1007/ s00264-014-2455-2 2. Ritter MA, Keating EM, Faris PM (1994) Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 76(1):35–38 3. Crevoisier XM, Reber P, Noesberger B (1998) Is suction drainage necessary after total joint arthroplasty? A prospective study. Arch Orthop Trauma Surg 117(3):121–124 4. Ovadia D, Luger E, Bickels J, Menachem A, Dekel S (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12(3):317–321
2652 5. Niskanen RO, Korkala OL, Haapala J, Kuokkanen HO, Kaukonen JP, Salo SA (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 15(5): 567–569 6. Kumar S, Penematsa S, Parekh S (2007) Are drains required following a routine primary total joint arthroplasty? Int Orthop 31(5):593–596. doi:10.1007/s00264-006-0245-1
International Orthopaedics (SICOT) (2014) 38:2651–2652 7. Sundaram RO, Parkinson RW (2007) Closed suction drains do not increase the blood transfusion rates in patients undergoing total knee arthroplasty. Int Orthop 31(5):613–616. doi:10.1007/s00264-0060232-6 8. Li C, Nijat A, Askar M (2011) No clear advantage to use of wound drains after unilateral total knee arthroplasty: a prospective randomized, controlled trial. J Arthroplasty 26(4):519–522. doi:10.1016/j. arth.2010.05.031
LETTER TO THE EDITOR
Comment on Quinn et al.: the use of postoperative suction drainage in total knee arthroplasty: a systematic review Jianzhong Hu & Lei Zeng & Hongbin Lu
Received: 5 October 2014 / Accepted: 20 October 2014 / Published online: 4 November 2014 # SICOT aisbl 2014
Dear editor, We read with great interest the article by Quinn et al. [1] entitled “The use of postoperative suction drainage in total knee arthroplasty: a systematic review” published online in July 2014 in International Orthopaedics. The authors performed a meta-analysis to compare no drainage and drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, and length of hospital stay and haemoglobin level following TKA. Overall, it is an interesting study. Nevertheless, we would like to communicate several queries to the authors. 1. The authors stated that “The random effect model was applied and the I 2 statistic described study heterogeneity” in the methods section. In their study, a fixed-effect model was still used for analysing the range of knee flexion (referring to Fig. 2 in Quinn’s article [1]). The weight of Adalberth’s study was up to 91.9 %. So it is necessary to discuss to what extent the results could be trusted. 2. The authors stated that six studies were included for analysis. After a quick research with the search algorithm “total OR knee arthroplasty OR replacement OR TKA OR TKR” AND “drainage OR drain”. Seven additional studies were found to meet the inclusion criteria [2–8]. This may have affected the final results. J. Hu : L. Zeng Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, People’s Republic of China H. Lu (*) Department of Sports Medicine, Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People’s Republic of China e-mail: [email protected]
3. In the results, both “range of motion” and “knee flexion” were used. The range of motion of knee includes knee flexion and knee extension. It is unreasonable to simply replace “range of motion” with “knee flexion”. 4. There was a slip of the pen in the results. The citation from 4 to 9 should be replaced with 9–14 in the results. 5. Several important measures, including infection, postoperative soft tissues ecchymosis, requirement for dressing reinforcement, deep venous thrombosis and requirement for homologous blood transfusion, were not analysed in the study. These might be limitations to this study. In conclusion, we do agree with the results of this metaanalysis by Quinn et al. Routine use of postoperative suction drains in primary total knee arthroplasty did not show improvements in terms of knee swelling or flexion, length of hospital stay or haemoglobin levels. Long-term follow up of individuals and larger multi-centre clinical RCTs are highly necessary to confirm the results.
References 1. Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J (2014) The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop. doi:10.1007/ s00264-014-2455-2 2. Ritter MA, Keating EM, Faris PM (1994) Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 76(1):35–38 3. Crevoisier XM, Reber P, Noesberger B (1998) Is suction drainage necessary after total joint arthroplasty? A prospective study. Arch Orthop Trauma Surg 117(3):121–124 4. Ovadia D, Luger E, Bickels J, Menachem A, Dekel S (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12(3):317–321
2652 5. Niskanen RO, Korkala OL, Haapala J, Kuokkanen HO, Kaukonen JP, Salo SA (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 15(5): 567–569 6. Kumar S, Penematsa S, Parekh S (2007) Are drains required following a routine primary total joint arthroplasty? Int Orthop 31(5):593–596. doi:10.1007/s00264-006-0245-1
International Orthopaedics (SICOT) (2014) 38:2651–2652 7. Sundaram RO, Parkinson RW (2007) Closed suction drains do not increase the blood transfusion rates in patients undergoing total knee arthroplasty. Int Orthop 31(5):613–616. doi:10.1007/s00264-0060232-6 8. Li C, Nijat A, Askar M (2011) No clear advantage to use of wound drains after unilateral total knee arthroplasty: a prospective randomized, controlled trial. J Arthroplasty 26(4):519–522. doi:10.1016/j. arth.2010.05.031
