Purpose. The traditional use of pneumatic tourniquets and reinfusion drains in total knee replacement (TKR) has recently been challenged and the aim of our study was to compare the outcomes of three different blood management techniques in primary TKR. Methods. We prospectively conducted a study of 87 patients with mean age of 71 (44-91) years old. They were randomised into three groups: Group A: 29 patients without the use of tourniquet and reinfusion drain, Group B: 27 patients without the use of tourniquet and reinfusion drain but application of intraoperative cell salvage system and Group C: 31 patients with the use of tourniquet and reinfusion drain. All groups were well matched and all patients were reassessed at the 2. nd. postoperative day. Results. There was no difference between the postoperative haemoglobin drop (Group A: 3.6 g/dl; Group B: 3.3 g/dl; Group C: 3.2 g/dl) and allogenic blood transfusion rate (Group A: 6.8%; Group B: 7.4%; Group C: 6.4%). In Group B an average of 525 ml of blood was collected and an average of 148 ml of concentrated blood was reinfused. In Group C an average of 432 ml of blood was collected by the drain and an average of 324 ml of blood was reinfused. The 2. nd. postoperative day range of knee movements showed no significant difference. Only 2 Group C patients (6.4%) had postoperative thrombembolic events (one DVT, one TIA). Readmission rate due to knee stiffness and superficial wound problems did not revealed any significant difference. The average operative time (83 minutes) and hospital stay (5.3 days) were the same in all groups and there was no wound haematoma or deep infection in any groups. Conclusion. There was no statistical difference between the groups for any outcome measure

We have carried out a randomised, controlled trial on 70 patients having unilateral total knee replacement in which transfusion was either with homologous bank blood or by reinfusion of unwashed blood salvaged after operation. No complications or adverse effects were observed from reinfusion. The need for bank blood was reduced by 86% in the reinfusion group but, more importantly, the number of infective episodes was significantly less when the use of bank blood was avoided. The mean length of stay in hospital was also reduced by more than two days

We prospectively randomised 100 patients undergoing cemented total knee replacement to receive either a single deep closed-suction drain or no drain. The total blood loss was significantly greater in those with a drain (568 ml versus 119 ml, p < 0.01; 95% CI 360 to 520) although those without lost more blood into the dressings (55 ml versus 119 ml, p < 0.01; 95% CI −70 to 10). There was no statistical difference in the postoperative swelling or pain score, or in the incidence of pyrexia, ecchymosis, time at which flexion was regained or the need for manipulation, or in the incidence of infection at a minimum of five years after surgery in the two groups. We have been unable to provide evidence to support the use of a closed-suction drain in cemented knee arthroplasty. It merely interferes with mobilisation and complicates nursing. Reinfusion drains may, however, prove to be beneficial

We undertook a prospective, randomised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with post-operative blood salvage in reducing blood loss in 212 total knee arthroplasties. The mean post-operative drained blood volume after drain clamping was 352.1 ml compared to 662.3 ml after blood salvage (p < 0.0001). Allogenic blood transfusion was needed in one patient in the drain group and for three in the blood salvage group. Drain clamping with intra-articular injection of saline with adrenaline is more effective than post-operative autologous blood transfusion in reducing blood loss during total knee arthroplasty.

In this paper, we consider wound healing after total knee arthroplasty.

We undertook a prospective randomised controlled trial to investigate the efficacy of autologous retransfusion drains in reducing the need for allogenic blood requirement after unilateral total knee replacement. We also monitored the incidence of post-operative complications. There were 86 patients in the control group, receiving standard care with a vacuum drain, and 92 who received an autologous drain and were retransfused postoperatively. Following serial haemoglobin measurements at 24, 48 and 72 hours, we found no difference in the need for allogenic blood between the two groups (control group 15.1%, retransfusion group 13% (p = 0.439)). The incidence of post-operative complications, such as wound infection, deep-vein thrombosis and chest infection, was also comparable between the groups. There were no adverse reactions associated with the retransfusion of autologous blood.

Based on this study, the cost-effectiveness and continued use of autologous drains in total knee replacement should be questioned.