What question did this study set out to answer?

To compare outcomes of total knee arthroplasty with and without suction drainage, focusing on safety and efficacy.

March 27, 2026Journal of orthopaedic surgery0 citationsOpen Access

Postoperative hematoma evaluation and subsequent infection in primary total knee arthroplasty without suction drainage compared to those with drainage

CYCheng-Han YehMemorial Hospital of South Bend HCHung-Yen ChenMemorial Hospital of South Bend JCJiun-Liang ChenMemorial Hospital of South Bend

Key Points

To compare outcomes of total knee arthroplasty with and without suction drainage, focusing on safety and efficacy.
Retrospective review of 901 patients undergoing primary total knee arthroplasty over 2 years
Comparison between groups: drain (91 TKAs) vs. no drain (842 TKAs)
Assessment of demographics, hematoma formation, anticoagulant use, and complications
One infection occurred in the drain group; no hematomas or joint infections were reported.
Ten infections and four hematomas developed in the non-drain group.
The hematoma subgroup had a significantly higher incidence of prosthetic joint infection (p = 0.008) compared to the non-aspiration subgroup.

Abstract

Objectives Closed suction drains are frequently used in the total knee arthroplasty (TKA) procedures for reducing pain, bruising edema and hematoma formation. Recent literature suggested no benefit of setting drains. The purposes of this study are to compare the outcomes between non-drain and drain groups, to identify the efficacy and safety of TKA without closed drainage, and to assess the prognosis of postoperative hematomas after TKA. Materials and Methods We retrospectively reviewed 901 patients with 933 knees, which performed primary total knee arthroplasty within 2 years. Ninety-one TKAs with drainage tube and 842 TKAs without setting drainage were enrolled in this study. The TKAs without drain were divided into the hematoma subgroup and the non-aspiration subgroup. Demographics, hematoma formation, anticoagulants use, perioperative hemoglobulin, and postoperative complications, were compared between these two groups. Results One knee of the drain group had cellulitis, and none developed hematoma and prosthetic joint infection. Ten TKAs developed prosthetic joint infection and 4 underwent surgical evacuation of a postoperative hematoma in the non-drain group. There was no significant relationship of postoperative complications between non-drain and drain groups. The hematoma subgroup had a significant higher incidence of PJI ( p = 0.008) than the no aspiration subgroup. Conclusions Primary TKA performed without postoperative suction drain under the combination use of intravenous and intra-articular tranexamic acid can be advocated as a safe procedure. Postoperative hematoma formation after TKA without drainage revealed a significant higher risk of periprosthetic joint infection. Our study demonstrated the drain group revealed lower incidence of hematoma formation, periprosthetic joint infection and cellulitis than the non-drain group, which should be interpreted with caution and may highlight the importance of careful monitoring for adverse outcomes when drainage is not used after TKA.

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