Retrospective analysis of the optimization of closed suction drainage regimens in early rehabilitation after total hip arthroplasty

doi:10.3877/cma.j.issn.2096-0263.2026.01.007

Abstract

Abstract:

Objective

Closed suction drainage (CSD) is routinely used to reduce postoperative hematoma formation in surgical procedures such as total hip arthroplasty (THA). However, persistent drainage from the drain site often continues after tube removal. This study aimed to investigate whether oblique drain placement can effectively shorten postoperative drain-site drainage duration and promote recovery in patients undergoing THA and similar surgeries.

Methods

A retrospective analysis was conducted on 51 patients (21 males, 30 females; mean age 57.9±11.4 years) who underwent simultaneous bilateral primary THA at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between March 2018 and October 2019. Each patient had the same diagnosis in both hips, with one side receiving oblique drain placement and the contralateral side receiving traditional straight drain placement as an internal control. Outcome measures included drainage volume and duration after tube removal, pain scores, hip function assessed by the Harris Hip Score (HHS), and postoperative complications.

Results

No difference was observed in postoperative day 1 drainage volume between the two techniques (168.6±17.3 vs 170.2±18.7 mL, t=0.441, P=0.661). Oblique drain placement significantly shortened the duration of postoperative drainage (2.4±0.6 vs 3.8±0.8 days, t=9.670, P<0.01) and markedly reduced the incidence of drainage lasting >3 days (3/51 vs 31/51, χ²=24.5, P<0.05). At 24, 48, and 72 hours after tube removal, dressing stain areas were significantly smaller in the oblique placement group (all P<0.01). VAS scores differed significantly between groups on postoperative day 3 (5.33±0.74 vs 6.24±0.79, F=5.913, P<0.001). HHS values showed significant differences at postoperative day 3, discharge, and 1 month (e.g., POD3: 51.57±5.63 vs 44.55±4.82, F=6.763, P<0.001). Hematoma thickness on postoperative day 3 did not differ between groups (3.8±2.8 vs 4.1±2.5 mm, t=0.464, P=0.645), and no deep infection or DVT occurred in any patient.

Conclusion

Oblique drain placement can shorten postoperative drainage duration following THA and facilitate early recovery.

Key words: Closed Suction Drainage, Oblique catheterization, Accelerated recovery, Total hip arthroplasty

Hao Xu, Yangyang Shi, Jie Jia, Wei Tong, Hongtao Tian. Retrospective analysis of the optimization of closed suction drainage regimens in early rehabilitation after total hip arthroplasty[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2026, 12(01): 47-53.

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Figures/Tables 7

References 23

1	Vendittoli P-A, Pellei K, Desmeules F, et al. Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs [J]. Orthop Traumatol Surg Res, 2019, 105(7): 1237-1243.
2	Li J, Zhu H, Liao R. Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial [J]. Trials, 2019, 20(1): 599.
3	Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review [J]. JAMA Surg, 2017, 152(3): 292.
4	Ferguson RJ, Palmer AJ, Taylor A, et al. Hip replacement [J]. The Lancet, 2018, 392(10158): 1662-1671.
5	Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty [J]. The Lancet, 2012, 380(9855): 1768-1777.
6	Waugh TR, Stinchfield FE. Suction drainage of orthopaedic wounds [J]. J Bone Joint Surg Am, 1961, 43-A: 939-946.
7	Strahovnik A, Fokter SK, Kotnik M. Comparison of Drainage Techniques on Prolonged Serous Drainage after Total Hip Arthroplasty [J]. J Arthroplasty, 2010, 25(2): 244-248.
8	Koyano G, Jinno T, Koga D, et al. Is Closed Suction Drainage Effective in Early Recovery of Hip Joint Function? Comparative Evaluation in One-Stage Bilateral Total Hip Arthroplasty [J]. J Arthroplasty, 2015, 30(1): 74-78.
9	Bartosz P, Grzelecki D, Chaberek S, et al. A prospective randomized study, use of closed suction drainage after revision hip arthroplasty may lead to excessive blood loss [J]. Sci Rep, 2022, 12(1): 881.
10	Kelly EG, Cashman JP, Imran FH, et al. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty [J]. Surg Technol Int, 2014, 24: 295-301.
11	Park C-W, Lim S-J, Yoo I, et al. Effects of disusing closed suction drainage in simultaneous bilateral total hip arthroplasty: A retrospective cohort study [J]. PloS One, 2021, 16(3): e0247845.
12	Cao J, Wang L, Liu J. The use of clamped drainage to reduce blood loss in total hip arthroplasty [J]. J Orthop Surg, 2015, 10(1): 130.
13	De Jong L, Klem TMAL, Kuijper TM, et al. Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur [J]. Bone Jt J, 2017, 99-B(8): 1088-1094.
14	Shahi A, Boe R, Bullock M, et al. The risk factors and an evidence-based protocol for the management of persistent wound drainage after total hip and knee arthroplasty [J]. Arthroplasty Today, 2019, 5(3): 329-333.
15	Wagenaar F-CBM, Löwik CAM, Zahar A, et al. Persistent Wound Drainage After Total Joint Arthroplasty: A Narrative Review [J]. J Arthroplasty, 2019, 34(1): 175-182.
16	Bryan AJ, Abdel MP, Sanders TL, et al. Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management [J]. J Bone Jt Surg, 2017, 99(23): 2011-2018.
17	Chen Z, Gao Y, Chen W, et al. Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials [J]. Eur J Orthop Surg Traumatol, 2014, 24(6): 939-946.
18	Ramesh BA, Evans JT, Marietta M, et al. Suction Drains [A]. StatPearls [M]. Treasure Island (FL): StatPearls Publishing, 2025.
19	Rajkumar J, Chopra P, Chintamani. Basic Physics Revisited for a Surgeon [J]. Indian J Surg, 2015, 77(3): 169-175.
20	Daga K, Milward GD, Pintos Dos Santos D, et al. A standardised comparison of chest and percutaneous drainage catheters to evaluate the applicability of the 'French’ sizing units [J]. Sci Rep, 2025, 15(1): 1601.
21	Joliat G-R, Ljungqvist O, Wasylak T, et al. Beyond surgery: clinical and economic impact of Enhanced Recovery After Surgery programs [J]. BMC Health Serv Res, 2018, 18(1): 1008.
22	Ishaku Z, Koshy DI, Adamu Bala M. Enhanced Recovery After Surgery (ERAS) Pathways in Elective Total Joint Arthroplasty [J]. Cureus, 2025.
23	Sundaram RO, Parkinson RW. Closed suction drains do not increase the blood transfusion rates in patients undergoing total knee arthroplasty [J]. Int Orthop, 2007, 31(5): 613-616.

项目	数据
病例数	51
男/女（例）	21/30
年龄（岁，±s）	57.9±11.4
身高（cm，±s）	157.8±7.3
体重（kg，±s）	65.6±8.2
BMI（kg/m²，±s）	26.3±2.2
诊断
髋关节炎[例（%）]	19（37.3）
股骨头坏死[例（%）]	32（62.7）

项目	数据
病例数	51
男/女（例）	21/30
年龄（岁，±s）	57.9±11.4
身高（cm，±s）	157.8±7.3
体重（kg，±s）	65.6±8.2
BMI（kg/m²，±s）	26.3±2.2
诊断
髋关节炎[例（%）]	19（37.3）
股骨头坏死[例（%）]	32（62.7）

组别	术后第一天引流量（ml）	伤口深度（cm）	拔管后渗液时间（d）	渗液超3天例数（例）	术后3天血肿情况（mm）
斜行-CSD	168.6±17.3	3.1±0.6	2.4±0.6	3/51	4.0（1.6，6.1）
直行-CSD	170.2±18.7	3.0±0.5	3.8±0.8	31/51	4.0（2.6，5.8）
χ²/t值	0.441	-0.934	9.670	24.5	1 227.5
P值	0.661^a	0.355^a	<0.01^a	<0.05^b	0.627^c

组别	术后第一天引流量（ml）	伤口深度（cm）	拔管后渗液时间（d）	渗液超3天例数（例）	术后3天血肿情况（mm）
斜行-CSD	168.6±17.3	3.1±0.6	2.4±0.6	3/51	4.0（1.6，6.1）
直行-CSD	170.2±18.7	3.0±0.5	3.8±0.8	31/51	4.0（2.6，5.8）
χ²/t值	0.441	-0.934	9.670	24.5	1 227.5
P值	0.661^a	0.355^a	<0.01^a	<0.05^b	0.627^c

组别	24 h	48 h	72 h	χ²值	P值
斜行-CSD	12.10（9.85，14.00）	1.70（1.40，2.75）^*	0.60（0.40，0.80）^*#	102.000	<0.001
直行-CSD	129.50（119.60，193.45）	72.10（62.30，85.50）^*	5.80（1.65，11.70）^*#	98.420	<0.001
Z值	-8.621	-8.610	-7.530
P值	<0.001	<0.001	<0.001

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