A prospective randomized trial examining the use of a closed suction drain shows no influence on strength or function in primary total knee arthroplasty

Aims

The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications.

Patients and Methods

A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction (‘sham drain’). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student’s t-tests or Wilcoxon’s signed-rank tests.

Results

No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery.

Conclusion

The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84–90

The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow-up

We conducted a retrospective review of 192 consecutive revision hip arthroplasties with an extended proximal femoral osteotomy performed from 1992 through January 1998. Of these osteotomies, 166 had a minimum of 2 years of clinical and radiographic follow-up (range, 2-7.5 years; average, 3 years, 9 months). All patients had a femoral reconstruction with an extended trochanteric osteotomy and an extensively porous-coated, cementless femoral component. The average age at revision was 65.8 years (range, 26-84 years). Of the 166 osteotomies, 2 nonunions (1.2%) and 1 malunion (0.6%) were identified. Seventeen hips (10.2%) required reoperation. Pain and walking scores improved from a mean of 6.5 preoperatively to 9.8 postoperatively. The extended trochanteric osteotomy heals predictably and enhances the surgeons' ability to address many difficult issues encountered in revision arthroplasty.