ABSTRACT
<p><b>OBJECTIVE</b>To prospectively compare of no drain or with drain after unilateral total knee arthroplasty (TKA).</p><p><b>METHODS</b>A randomized prospective study was conducted between February 2006 and February 2007. The study included 100 patients who were divided into 2 groups: group A (n = 50), which included patients without drain release, and group B (n = 50), which included patients who had a drain release. The true total blood loss was calculated depending on the height, body mass and pre-and post-operative Hct, and hidden blood loss was gotten by subtracting the visible blood loss from total loss. The recovery after surgery, the correlative complications and transfusion amounts were compared and analyzed.</p><p><b>RESULTS</b>All 100 patients undergoing TKA were involved in the result analysis. In patients without a drain, the total blood loss was (535 +/- 295) ml and the hidden blood loss was (513 +/- 290) ml, in patients with a drain, the total blood loss was (853 +/- 331) ml and the hidden blood loss (689 +/- 324) ml. The total and hidden blood loss, blood transfusion amount between drain-group and without drain-group was significantly different (P < 0.05). The difference in the incidence of infection and post-op recovery and correlative complications did not reach statistical significance.</p><p><b>CONCLUSIONS</b>In patients having primary TKA, using a drain, compared with no use of a drain, does not show us a clear advantage that make us accept it. Without a drain release could present an effective and economic method for reducing blood loss and preventing blood transfusion in patients undergoing unilateral TKA.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Knee , Drainage , Postoperative Hemorrhage , Prospective StudiesABSTRACT
<p><b>BACKGROUND</b>After anterior cruciate ligament (ACL) reconstruction, some patients suffered from sensory disturbance around the surgical incision of the leg. This research was aimed to investigate the relationship between the different skin incisions and the injury of the infrapatellar branch of the saphenous nerve (IPBSN) post ACL reconstruction.</p><p><b>METHODS</b>ACL reconstructions were performed with quadruple hamstring tendon for 60 patients. Sensory disturbance around the skin incision was followed up at an average of 14.5 +/- 4.7 months post operation. Among the 60 patients, vertical incision for 35 patients and oblique incision for 25 patients were used for graft taking during ACL reconstruction. The lengths of the incisions were measured. The patients were asked to mark the sensory disturbance zone at follow up time, and then the marked area was measured. The IPBSN of 15 cadaver knees were anatomized. The distance between the IPBSN and the upper edge of the pes anserinus tendon at the middle point of the incision was measured. Independent-samples t-test, chi-square and Mann-Whitney tests were used for statistical analyses.</p><p><b>RESULTS</b>The patients' age (P = 0.329), the follow-up time (P = 0.681), and the incision length (P = 0.732) between the two groups had no significant difference. Twenty-three patients (65.7%) in the vertical incision group had IPBSN injury compared with 6 patients (24.0%) in oblique incision group (P = 0.002). The average sensory disturbance area in vertical incision group ((48.0 +/- 75.3) cm(2)) was significantly larger (P = 0.004) than that in the oblique group ((8.4 +/- 19.4) cm(2)). The anatomy measurement showed the average distance between IPBSN and the upper edge of the pes anserinus tendon was 0.6 cm at the incision.</p><p><b>CONCLUSIONS</b>Oblique incision with less risk of damage for IPBSN may be better for graft harvesting in ACL reconstruction. As the IPBSN is so near and parallel to the hamstring tendons, damage to the IPBSN is one of the potential complications for graft harvesting, regardless of the incision used. That's why even in the oblique incision group, 24% patients also had sensory disturbance complication.</p>