Wound drainage after total hip arthroplasty
Diseases and injuries of the hip joint take a significant place in the structure of orthopaedic pathology. Total hip arthroplasty is the main treatment method of the hip joint osteoarthritis of the III–IV stages and fractures of the femoral neck in the elderly people. Objective: to analyze the effectiveness of the postoperative wound management after total hip arthroplasty without draining. Methods: a group of 140 patients (age — from 45 to 78 years) who underwent total hip arthroplasty in the period from the beginning of 2017 to April 2019 was sampled for this study. Diagnosis: hip joint osteoarthritis of the III–IV stages, aseptic necrosis of the femoral head, rheumatoid arthritis and the femoral neck fracture. The patients were divided into groups: I — the wound was drained, II — the postoperative wound was without drainage. The groups did not differ in age, sex, body mass index and distribution of diagnosis. Results: blood loss during the operation did not differ and was equal in group I — (367.59 ± 16.19) ml, II — (351.6 ± 7.97) ml. The count of erythrocytes was significantly higher in group I, which characterizes less blood loss after surgery. Prior to surgery, ESR and CRP levels did not differ significantly in both groups. After the surgery and at discharge, we noted significantly lower markers of the inflammation in the I group of patients. The maximum intense of the pain according to VAS scale was 5 points for patients of the Ist group and 9 points in the IInd group. Body temperature in patients of the Ist group elevated up to 37.7°C, II — 39.4°C. There were no differences in the timing of postoperative wound healing. Patients were activated for the next day after the surgery. Patients in group I were discharged from the hospital on average of 2 days earlier than group II. Conclusions: in the group of patients without joint draining revealed faster normalization of erythrocytes, CRP and ESR, low intensity of postoperative pain according to VAS, shortened hospital stay.
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Tikhilov, R. M., Shubnyakov, I. I., Myasoedov, A. A., Pliev, D. G., Karelkin, V. V., & Berezin, G. V. (2018). Total hip in case of hip bone ankylosis different etiology, reasons and result. Modern problems of science and education, 2. doi: 10.17513/spno.27426 [in Russian].
Korzh, M. O., Filipenko, V. A. & Tankut, V. A. (2012). The current state of the problem of joint replacement in Ukraine. Pain, joints, spine, 5 (1), 10–12. [in Ukrainian]
Zeng, W., Zhou, K., Zhou, Z., Shen, B., Yang, J., Kang, P., & Pei, F. (2014). Comparison between Drainage and Non-drainage after Total Hip Arthroplasty in Chinese Subjects. Orthopaedic Surgery, 6 (1), 28–32. doi:10.1111/os.12092
Lindeque, B., Hartman, Z., Noshchenko, A., & Cruse, M. (2014). Infection after primary total hip arthroplasty. Orthopedics, 37 (4), 257–265. doi:10.3928/01477447-20140401-08
Shahi, A., Boe, R., Bullock, M., Hoedt, C., Fayyad, A., Miller, L., & Oliashirazi, A. (2019). The risk factors and an evidence-based protocol for the management of persistent wound drainage after total hip and knee arthroplasty. Arthroplasty Today, 5 (3), 329–333. doi:10.1016/j.artd.2019.05.003
Chen, Z., Gao, Y., Chen, W., Li, X., & Zhang, Y. (2013). Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials. European Journal of Orthopaedic Surgery & Traumatology, 24 (6), 939–946. doi:10.1007/s00590-013-1284-0
Parvizi, J., Fassihi, S. C., & Enayatollahi, M. A. (2016). Diagnosis of periprosthetic joint infection following hip and knee arthroplasty. Orthopedic Clinics of North America, 47 (3), 505–515. doi:10.1016/j.ocl.2016.03.001
Tjeenk, R., Peeters, M., Vandenende, E., Kastelein, G., & Breslau, P. (2005). Wound drainage versus non-drainage for proximal femoral fracturesA prospective randomised study. Injury, 36 (1), 100–104. doi:10.1016/s0020-1383(04)00174-3
Dora, C., Von Campe, A., Mengiardi, B., Koch, P., & Vienne, P. (2006). Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations. Archives of Orthopaedic and Trauma Surgery, 127 (10), 919–923. doi:10.1007/s00402-006-0260-0
Ghanem, E., Heppert, V., Spangehl, M., Abraham, J., Azzam, K., Barnes, L. … & Stefansdottir, A. (2014). Wound management. Journal of Orthopaedic Research, 32, 1, S108–119. doi: 10.1002/jor.22554.
Ghaly, D., Khalifa, Y. M., Bakr, H. A., & Mahran, M. A. (2018). To use closed suction drain or not after total hip arthroplasty; A randomized controlled trial? Journal of Current Medical Research and Practice, 3 (3), 180-186. doi:10.4103/jcmrp.jcmrp_1_18
Ting, N. T., & Della Valle, C. J. (2017). Diagnosis of periprosthetic joint infection – an algorithm-based approach. The Journal of Arthroplasty, 32 (7), 2047–2050. doi:10.1016/j.arth.2017.02.070
Simons, M. J., Amin, N. H., & Scuderi, G. R. (2017). Acute wound complications after total knee arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 25 (8), 547–555. doi:10.5435/jaaos-d-15-00402
Ravikumar, K., Alwan, T., Fordyce, M., & Tuson, K. (2001). Drainage versus Non-Drainage in Total Hip Arthroplasty. A Prospective Randomised Study. HIP International, 11 (1), 49–54. doi:10.1177/112070000101100106
Babalian, V. O. (2018). Analysis of post operation period after primary hip arthroplasty in proximal femoral fracture depending on postsurgery wound drainage. ScienceRise. Medical Science, 7 (27), 4–7. doi: 10.15587/2519-4798.2018.149293. [in Ukrainian]
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