The use of wound drains in total hip replacement surgery

For virtually three decades wound drains were used almost routinely in total joint replacement without question and were considered essential. On reviewing the literature, however, the scientific evidence for their use is scanty. More recently, a number of relatively small studies have questioned their value. It was therefore decided to carry out a large, definitive study to determine whether or not the use of a wound drain affected the outcome in primary total hip replacement. In July 1994, a prospective, randomized control trial began in Musgrave Park Hospital. A total of 872 primary total hip replacements were included (440 with a drain and 432 without). A number of different parameters were measured in thepostoperative period including blood loss, wound and drain site ooze, haematoma formation and wound infection. The study found no evidence to suggest that drains are actually harmful to patients, but they do not appear to be necessary. Consequently, it is proposed that postoperative drainage systems offer little advantage in the outcome of primary total hip replacements. A saving of £ 12 508 could be made over the course of a year if no drains at all were used for patients undergoing total hip replacement surgery in the study hospital (drain per unit cost £7. 16×1747, 1995/96).