Meta-analysis of Temporary Versus No Clamping in TKA

Abstract

Educational Objectives: As a result of reading this article, physicians should be able to: 1. Identify the available drainage systems used for patients who undergo total knee arthroplasty (TKA). 2. Understand the potential strengths and limitations of temporary and no clamping drainage used in TKA. 3. Become familiar with the available evidence regarding the advantages of temporary and no clamping drainage used in TKA. 4. Understand the optimal time of temporary drainage clamping in association with TKA based on the available evidence. Use of closed drainage systems after total knee arthroplasty (TKA) is a routine practice. Currently, a debate exists regarding whether temporary or no clamping is optimal. A systematic review of the English literature was conducted, and randomized controlled trials comparing all forms of temporary or no clamping drainage were included. Two authors independently extracted articles and predefined data. Data were pooled using a fixed-effects model to perform the meta-analysis. Nine randomized controlled trials totaling 850 patients were retrieved. The results indicate that temporary clamping could significantly reduce the drainage volume, including total drainage volume, drainage volume within 24 hours postoperatively, and drainage volume within 48 hours postoperatively. Furthermore, patients treated with temporary drainage clamping for 4 hours or more had a higher hemoglobin level 24 hours postoperatively than the patients treated with no clamping, and the number of blood transfusions per patient decreased significantly. No significant difference was identified between the 2 practices regarding postoperative range of motion, wound-related complications, and deep vein thrombosis. More randomized controlled trials are needed to provide robust evidence and to definitively determine which practice is most effective in reducing postoperative blood loss.