Autologous blood transfusion drainage compared with no drainage in total knee arthroplasty: a meta-analysis and systematic review

ABSTRACT

This is the first meta-analysis to assess the clinical efficiency, safety and potential advantages regarding the use of ABT drains compared with no drainage which is controversial in total knee arthroplasty [TKA].A comprehensive literature search was carried out in March 2015 using the PubMed, Embase, and Cochrane Library databases. A meta-analysis was carried out on two retrospective comparative studies [RCSs] and five randomized controlled trials [RCTs]. The number of patients receiving homologous blood transfusion was the primary outcome of the meta-analysis; the secondary outcome measure was the mean drop in Hb level in comparison to the mean pre-operative HB level, the range of flexion of the knee joint, and infections of the wound after surgery. A total of 868 patients, who were included in two retrospective studies and five RCTs, were distributed into subgroups for the meta-analysis. This pooled data showed no benefit of ABT drainage compared no drainage in the homologous blood transfusion rate [13.05% and 16.91%, OR0.73[0.47,1.13], Z=1.41, P=0.016;and 3.49% and 6.54%, OR 0.50[0.12,2.01], Z=0.98,P=0.033,respectively in subgroups], Hb drop [Weight mean differences [WMD] 0.20[-0.28,0.68], Z=0.82,P=0.41;WMD0.16[-0.41,0.55], Z=0.93, P=0.35, respectively], range of flexion of the knee joint [WMDr-0.82 [-3.35,1.70], Z =0.64,P=0.52]and wound infection [OR0.25[0.61,10.20]; Z =1.28, p=0.2] after TKA surgery. Our findings do not recommend the routine use of postoperative ABT drainage in total knee arthroplasty. Well-designed RCTs with large sample sizes, longer term measures and extensive follow-up period should be performed in the future to update the findings of this study