Results of patients who were followed up with special dressings without the use of drains after primary total knee arthroplasty
Öz
Objective: This study aimed to compare the clinical and functional results of patients who used drains with those who used compressive dressings without drains after tourniquetless total knee arthroplasty (TKA) for primary gonarthrosis.
Methods: Between January 2019 and June 2023, 316 patients who underwent total knee replacements were evaluated retrospectively. After excluding patients who used tourniquets, 120 patients who met the inclusion criteria were included in the study. Postoperative hemoglobin changes, early–late postoperative edema, pain, range of motion (ROM), clinical scores, and functional outcomes were evaluated and compared in 68 patients (18 males and 50 females) and 52 patients (11 males and 41 females).
Results: There was no significant difference in preoperative and postoperative hemoglobin values, 6th week Knee Society Score (KSS)–knee, and KSS-functional scores between patients with and without drains (p > 0.05). Although there was a statistically significant difference in ROM on the first postoperative day, there was no statistically significant difference in the postoperative second-week ROM. There was a significant difference in Day 1 and 3 visual analog scale (VAS) scores between patients with and without drains (p < 0.001).
Conclusion: According to the findings of this study, using a drain after primary TKA is unnecessary. Although the clinical results of patients without a drain after total knee arthroplasty are similar to those with a drain, patients can be treated and followed up with compressive dressings without a drain.
Anahtar Kelimeler
Complication Compressive bandage Drain Total knee replacement.
Kaynakça
- Sehat KR. Hidden blood loss following hip and knee arthroplasty: Correct management of blood loss should take hidden loss into account. J Bone Joint Surg 2004;86-B(4):561-5.
- Goodnough LT, Verbrugge D, Marcus RE. The relationship between hematocrit, blood lost, and blood transfused in total knee replacement. Implications for postoperative blood salvage and reinfusion. Am J Knee Surg 1995;8(3):83-7.
- Themistoklis T, Theodosia V, Konstantinos K, Georgios DI. Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now? World J Orthop 2017;8(6):441-54.
- Hui S, Peng Y, Tao L, Wang S, Yang Y, Du Y, vd. Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis. J Orthop Surg 2021;16:401.
- Titley-Diaz WH, De Cicco FL. Suture hypersensitivity. Treasure Island (FL): StatPearls Publishing; 2023.
- Brunner W, Härle A. [Risks of wound infection caused by drainage]. Z Orthop Ihre Grenzgeb 1989;127(4):510-2.
- Bullocks J, Basu CB, Hsu P, Singer R. Prevention of hematomas and seromas. Semin Plast Surg 2006;20(4):233-40.
- Guo H, Wang B, Ji Z, Gao X, Zhang Y, Yuan L, vd. Closed drainage versus non-drainage for single-level lumbar discectomy: a prospective randomized controlled study. BMC Musculoskelet Disord 2020;21:484.
- Jeon YS, Park JS, Kim MK. Optimal release timing of temporary drain clamping after total knee arthroplasty. J Orthop Surg 2017;12:47.
- Maniar RN, Pradhan P, Bhatnagar N, Maniar A, Bidwai R, Bindal P. Role of suction drain after knee arthroplasty in the tranexamic acid era: A randomized controlled study. Clin Orthop Surg 2019;11(1):73-81.
- Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 2013;37(11):2109-18.
- Yaddanapudi S, Yaddanapudi L. Indications for blood and blood product transfusion. Indian J Anaesth 2014;58(5):538-42.
- Wick MR, Moore S, Taswell HF. Non-A, non-B hepatitis associated with blood transfusion. Transfusion (Paris) 1985;25(2):93-101.
- Si HB, Yang TM, Zeng Y, Shen B. No clear benefit or drawback to the use of closed drainage after primary total knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016;17:183.
- Gold MS, Gebhart GF. Nociceptor sensitization in pain pathogenesis. Nat Med 2010;16(11):1248-57.
Primer total diz artroplastisi sonrası dren kullanılmadan özellikli kompressif pansumanla takip edilen hastaların sonuçları
Öz
Amaç: Çalışmamızda primer gonartroz nedeniyle, turnikesiz total diz artroplastisi (TDA) yapılan hastalarda, dren kullanılan hasta grubuyla dren kullanılmayıp kompresif pansuman yapılan hasta grubunu klinik ve fonksiyonel olarak karşılaştırmayı amaçladık.
Gereç Yöntem: 2019-Ocak ile 2023-Haziran tarihleri arasında total diz protezi gerçekleştirilen 316 hasta retospektif olarak değerlendirildi. Turnike kullanımı olan hastaların çalışma dışı bırakılması sonrasında dahil edilme kriterlerini içeren 120 hasta çalışmaya dahil edildi. Dren kullanılan 68 hasta (18 erkek,50 kadın) ile dren kullanılmayan 52 hastanın (11 erkek, 41 kadın) post-operatif hemoglobin değişiklikleri, cerrahi sonrası erken dönem ödemleri, ağrı durumları, hareket açıklıkları, klinik skorları ve fonskiyonel sonuçları değerlendirilerek birbiri ile karşılaştırıldı.
Bulgular: Dren kullanımı olmayan hastalar dren kullanılan hastalarla karşılaştırıldığında hastaların pre-operatif ve post-operatif dönem hemoglobin değerlerinde, 6. hafta Knee Society Score (KSS)-diz ve KSS-fonksiyonel skorlarında anlamlı bir fark olmadığı görüldü. (p>0.05) Post-operatif 1.gün range of motion (ROM)’larında istatistiksel olara anlamlı fark olmakla beraber post op 2.hafta ROM’ları arasında istatistiksel olarak bir fark gözlenmedi. Dren kullanılmayan hastaların 1.gün ve 3.gün Visual Analogue Scale (VAS) skorlarında dren kullanılanlara göre anlamlı fark olduğu izlendi. (p <0.001)
Sonuç: Bu çalışmayla, primer TDA sonrası dren kullanımının mutlak gereklilik olmadığı sonucuna varılmıştır, Total diz artroplastisi sonrası dren kullanılmayan hastaların klinik sonuçları dren kullanılanlarla benzer olmakla beraber dren kullanılmadan kompressif pansuman yapılarak, hastaların tedavisi ve takibi mümkündür.
Anahtar Kelimeler
Kaynakça
- Sehat KR. Hidden blood loss following hip and knee arthroplasty: Correct management of blood loss should take hidden loss into account. J Bone Joint Surg 2004;86-B(4):561-5.
- Goodnough LT, Verbrugge D, Marcus RE. The relationship between hematocrit, blood lost, and blood transfused in total knee replacement. Implications for postoperative blood salvage and reinfusion. Am J Knee Surg 1995;8(3):83-7.
- Themistoklis T, Theodosia V, Konstantinos K, Georgios DI. Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now? World J Orthop 2017;8(6):441-54.
- Hui S, Peng Y, Tao L, Wang S, Yang Y, Du Y, vd. Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis. J Orthop Surg 2021;16:401.
- Titley-Diaz WH, De Cicco FL. Suture hypersensitivity. Treasure Island (FL): StatPearls Publishing; 2023.
- Brunner W, Härle A. [Risks of wound infection caused by drainage]. Z Orthop Ihre Grenzgeb 1989;127(4):510-2.
- Bullocks J, Basu CB, Hsu P, Singer R. Prevention of hematomas and seromas. Semin Plast Surg 2006;20(4):233-40.
- Guo H, Wang B, Ji Z, Gao X, Zhang Y, Yuan L, vd. Closed drainage versus non-drainage for single-level lumbar discectomy: a prospective randomized controlled study. BMC Musculoskelet Disord 2020;21:484.
- Jeon YS, Park JS, Kim MK. Optimal release timing of temporary drain clamping after total knee arthroplasty. J Orthop Surg 2017;12:47.
- Maniar RN, Pradhan P, Bhatnagar N, Maniar A, Bidwai R, Bindal P. Role of suction drain after knee arthroplasty in the tranexamic acid era: A randomized controlled study. Clin Orthop Surg 2019;11(1):73-81.
- Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 2013;37(11):2109-18.
- Yaddanapudi S, Yaddanapudi L. Indications for blood and blood product transfusion. Indian J Anaesth 2014;58(5):538-42.
- Wick MR, Moore S, Taswell HF. Non-A, non-B hepatitis associated with blood transfusion. Transfusion (Paris) 1985;25(2):93-101.
- Si HB, Yang TM, Zeng Y, Shen B. No clear benefit or drawback to the use of closed drainage after primary total knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016;17:183.
- Gold MS, Gebhart GF. Nociceptor sensitization in pain pathogenesis. Nat Med 2010;16(11):1248-57.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Aralık 2024 |
| Gönderilme Tarihi | 25 Aralık 2023 |
| Kabul Tarihi | 29 Temmuz 2024 |
| Yayımlandığı Sayı | Yıl 2024 |