Does closed suction drainage reduce postoperative hematoma and muscle swelling after total hip arthroplasty? A retrospective comparative study using computed tomography

Abstract Purpose Closed suction drainage has been used after total hip arthroplasty (THA) to prevent hematoma, muscle swelling, and complications, but its effectiveness remains controversial. This study evaluated the effects of drains on postoperative hematoma, muscle swelling, and clinical outcomes. Methods A total of 168 patients who underwent unilateral cementless THA via the posterior approach for secondary hip osteoarthritis due to developmental dysplasia were retrospectively reviewed. Among them, 60 matched pairs, with and without drains, were selected using propensity score matching based on age, sex, body mass index, operative time, and femoral stem type. The primary outcome was the percentage increase in under-fascial area (UFA) measured on axial computed tomography at the teardrop level. UFA was used as a surrogate marker of postoperative hematoma and muscle swelling and was assessed preoperatively and on postoperative day 7. Secondary outcomes included postoperative estimated blood loss (PEBL), pain (assessed using the numeric rating scale), and laboratory parameters (albumin, hemoglobin, white blood cell count, creatine kinase, and C-reactive protein) on postoperative days 1, 4, 7, and 14. Results The mean percentage increase in the UFA did not differ between groups (10.7% [no-drain] vs. 11.2% [drain], P = 0.63). No significant differences were found in the PEBL, numeric rating scale pain scores on day 3, or laboratory parameters beyond postoperative day 14. Conclusion Closed suction drainage did not reduce the UFA increase or improve clinical outcomes after THA. The routine use of drains may not be warranted considering the absence of demonstrable benefits and potential risks.