Short-term outcomes of improvised closed suction drainage versus no drainage after primary total knee arthroplasty: A prospective Cohort Study

Total knee arthroplasty (TKA) is increasingly performed, yet the utility of closed suction drains remains debated, particularly in resource-limited settings. Drains aim to reduce hematoma but may increase blood loss. This study compares short-term outcomes following primary TKA using an improvised closed suction drain versus no drainage at a tertiary orthopaedic centre in Tanzania, where standard drains may be unavailable. This prospective cohort study enrolled 50 consecutive patients undergoing primary TKA at Muhimbili Orthopaedic Institute. Patients receiving an improvised closed suction drain (n=11; modified IV set connected to vacuum bottle) were compared to those without a drain (n=39), based on surgeon preference. Data collected included demographics, pre- and postoperative hemoglobin (Hb) levels (measured days 3-5 post-op), allogeneic blood transfusion rates, length of hospital stay (LOS), and daily pain scores (Numeric Rating Scale 0-10) for 5 days. Independent t-tests and Fisher’s exact test were used for comparisons (P < 0.05). The cohort comprised 50 patients (88% female). The drain group had significantly lower mean postoperative Hb levels (8.46 ± 1.36 g/dL) compared to the no-drain group (9.79 ± 1.40 g/dL), with a mean difference of 1.33 g/dL (95% CI 0.37–2.29, P = 0.007). The transfusion rate was significantly higher in the drain group (45.5% [5/11]) versus the no-drain group (2.6% [1/39]) (P = 0.001). There were no statistically significant differences in mean LOS (Drain: 6.45 ± 3.35 days vs. No Drain: 5.25 ± 1.60 days; P = 0.100) or mean daily pain scores (P = 0.701). In this Tanzanian cohort undergoing primary TKA, using an improvised closed suction drain was associated with significantly lower postoperative hemoglobin levels and a higher blood transfusion rate, without offering advantages in reducing hospital stay or postoperative pain. Routine use of such drains may be disadvantageous, particularly considering blood resource limitations.