Are Post-Operative Drains Beneficial in Total and Reverse Total Shoulder Arthroplasty?

Brandon J. Erickson*, Kirk Campbell, Akshay Jain, Gregory L. Cvetanovich, John D. Higgins, Rachel M. Frank, Gregory P. Nicholson and Anthony A. Romeo

Are Post-Operative Drains Beneficial in Total and Reverse Total Shoulder Arthroplasty?

Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty  have become
common procedures performed by sports medicine, shoulder and elbow,
as well as trauma orthopaedic surgeons.

In 2011 there were an estimated 66,485 shoulder arthroplasty procedures
performed in the United States. Indications for TSA and RTSA include glenohumeral
arthritis, rotator cuff arthropathy, three and four part proximal humerus fractures, and others.

While some surgeons routinely place a drain post-operatively following TSA and RTSA, others
do not. Currently there are no studies in the literature that have compared outcomes, complications,
and change in hemoglobin levels in patients undergoing TSA or RTSA who have either
had a closed-suction drain placed versus those who did not have a drain placed.

There have been several studies following total and unicompartmental
knee arthroplasty as well as total hip arthroplasty that have evaluated the use of post-operative closed-suction drains.5-7 While many surgeons still routinely use post-operative drains following total knee arthroplasty (TKA), the data
suggests this is unnecessary. Bjerke-Kroll et al reviewed the use
of post-operative drains in patients following 598 TKA and 536
total hip arthroplasties (THA).

The authors found that not only was the use of a post-operative drain associated with an increase
in cost of $538 for a THA and $455 for a TKA, but THA and TKA patients
who had a post-operative drain placed had an increase in the number of allogeneic
blood transfusion, estimated blood loss, and the THA patients had an increased length of hospital stay.

Similarly, Al-Zahid et al found no benefit with the use of post-operative
closed-suction or re-infusion drains following
primary, elective TKA.

Orthop Res Traumatol Open J. 2016; 1(1): 22-27. doi: 10.17140/ORTOJ-1-105