Use of postoperative suction drainage in bipolar arthroplasty for hip fracture

Purpose of the study Suction drainage in bipolar arthroplasty for hip fracture is standard proce dure despite the lack of a solid scientific basis. No study is reported in the literature demonstrating an advantage of systematic drainage. The aim o f this work was to search for reasons why this conventional practice should be continued. Material and methods A prospective randomized study in a homogeneous consecutive group of patien ts hospitalized in our unit for hip fracture were included in the study fro m January 1995 through January 1999. Among the 183 patients, 97 were exclud ed (hemostasis disorders or anticoagulant treatment, multiple fractures, pr eoperative anemia with Hg < 9.5 g/dl, postponed operation). For the 86 incl uded patients, the posterolateral Moore access was used to implant a sealed intermediary prosthesis. According to random selection, drainage was then installed or not. Outcome criteria were number of reoperations, hemoglobin level on D0, D1, D2, D5, and D10, number of patients requiring transfusion and number of packed red cell units in each group, and finally, temperature as reflecting presence of possible hematome (D0, D2, D5, D10). Results The two groups were similar for age and sex. There were no reoperations for hematoma or superficial infection and only one patient was reoperated for early dislocation in the group without drainage. Twenty-seven patients had transfusions, 14 in the drainage group and 13 in the no drainage group; mea n number of packed red cell units was 2. Hemoglobin level fell similarly in the two groups in DO (2.1 versus 1.9), D2 (2.5 versus 2.4), D (2.7 versus 2.7), D10 (2.4 versus 2.6) as did mean temperatures. Discussion We were thus unable to demonstrate any advantage of using suction drainage in bipolar arthroplasty for hip fracture when using more access. This is in agreement with reports in the literature. Exception the simplification of nursing care by not using drains, the cost savings can be considerable in l ight of the number of patients treated. We recommend that systematic use of suction drainage be discontinued in bipolar arthroplasty for hip fracture.