Some surgeons do not use any drainages. The problem is that the routine use of anticoagulant prophylaxis and the uncemented prosthesis increase the risk of postoperative wound hematomas, eventually infection.
Dear Panayot
I am ortopedic surgeon with special interest in orthopedic trauma and I perform THR . I don't use suction drainages since 2000 and with this procedure I didn't find in my results more wound hematomas and infection when compared THR with suction drainages.
In my opinion the routine use of closed suction for elective hip arthroplasty may be of more harm than benefit as it results in an increase in the number of patients requiring blood transfusion. The only proven benefit of drains is a reduced need for a change of the dressing.
Tnank you for your proper answer, Dr. Nelson. Your arguements are very interesting. I use closed suction drainage in THR for many years. Routinely we administer low molecular heparin for prophylaxis of DVT and pulmonary embolism. This medication predisposes to a prolonged bleeding in the postoperative period. It is supposed that hematomas may occur and if they are nor evacuated through the drainage they may be a base for deep infection. These are out concerns. Do you carry out anticoagulant prophylaxis in THR routinely ? Do you use more uncemented prosthesis or cemented prosthesis ?
I use more frequently uncemented prosthesis and administer low molecular heparin for prophylaxis of DVT and pulmonary embolism.
What about the cases with major postoperative hematomas after hip arthroplasty ? Do you perform an early debridement, percutaneous evacuation or "wait and see" tactics accompanied by administration of antibiotics ?
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