Background With total knee replacement (TKR) surgery articular cartilage, meniscuses, articular ligaments are removed. Also articular effusion and hematoma formation increase following surgery. Therefore, proprioceptive acuity decrease after TKR surgery (1). Drainage is a common procedure in TKR, but its effectiveness is controversial. Some studies have claimed that drainage decreases the risk of articular effusion and hematoma formation. However, some studies have demonstrated that drainage increases postoperative blood loss and does not improve the surgical result (2). Several studies have examined the effect of using drainage, but they have not involved improvement in proprioception for patients who had drains compared with those who did not after TKR.
Objectives The aim of this study was to compare the effect of the drainage on proprioception acuity inpatients with total knee prosthesis.
Methods The study group consisted of 60 patients (95 knees), who underwent primary TKR because of arthrosis were consecutively allocated to a drainage group (n=26 (41 knees), with median age; 66.23±8.63 years), and were allocated to a non-drainage group (n=34 (54 knees), with median age; 63.97±8.99 years). Patients were evaluated regarding knee proprioception (in knee joint angle 15°, 30° and 60°), knee function score (Hospital for Special Surgery (HSS) score), pain (Numeric Pain Rating Scale (NPRS)), knee circumference, knee range of motion. Functional activities were evaluated using the Iowa Level of Assistance Scale and walking speed was evaluated using the Iowa Ambulation Velocity Scale. Patients were evaluated preoperatively and at discharge. All patients underwent the same rehabilitation program.
Results At baseline, demographic and anthropometric characteristics were similar in groups and there was no statistically difference between groups (p>0.05). When knee proprioceptive acuity measurements (in knee joint angle 15°, 30° and 60°) were compared before and after surgery, there was no statistical differences in proprioceptive acuity between groups (p>0.05). It was determined that; the drainage group had better results in terms of reduction of pain severity after surgery (p<0.001). When the HSS knee scores were compared there was statistically difference between groups (p=0.001) and the HSS knee scores were lower in non-drainage group after surgery. There were no statistical differences in knee circumference, knee range of motion, the IOWA help level score and IOWA walking speed score between groups after TKR (p>0.05).
Conclusions According to our results, the use of drainage did not improve the knee proprioceptive acuity inpatients with TKR. But, it is suggested that using drainage decreases pain severity and improves the HSS knee score. Also the use of drains has no effect on patients' outcomes after TKR, in terms of improvements knee range of motion, knee circumference, functional activities and walking speed.
Pap G, Meyer M, Weiler H-T, et al. Proprioception after total knee arthroplasty: a comparison with clinical outcome. Acta Orthopaedica Scandinavica. 2000;71(2):153–9.
Zhang QD, Guo WS, Zhang Q, et al. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis. The Journal of Arthroplasty. 2011;26(8):1265–1272.
Disclosure of Interest None declared
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