2017 ISAKOS Biennial Congress ePoster #1906

 

Are Drains Necessary in Shoulder Arthroplasty?

Christopher Chuinard, MD, MPH, Traverse City, MI UNITED STATES
Shota Hoshika, MD, Funabashi, Chiba JAPAN
Karen Miller, ATC, OTC, Traverse City, Mi UNITED STATES

Great Lakes Orthopaedic Center, Traverse City, Mi, UNITED STATES

FDA Status Cleared

Summary

A retrospective review of shoulder arthroplasty yields little evidience to support the routine use of drains.

Abstract

Purpose

Postoperative hematoma is a troubling complication after shoulder arthroplasty. We report our incidence of post-operative hematoma in cases of drain vs. no drain in total shoulder arthroplasty (both reverse and anatomic geometry).

Material And Methods

A retrospective review of all total shoulder arthroplasties (both anatomic and reverse architecture) performed at a single clinic from December 2006 to March 2011 yielded 411 shoulder arthroplasties performed by 2 fellowship trained shoulder surgeons who utilize similar techniques. The senior surgeon used drains only in cases where the patient had been on anti-coagulants, revisions, or significant intra-operative blood loss. The junior surgeon routinely drained all shoulder arthroplasties. All patients were available for a chart review and radiographs. A second review by the senior surgeon for patients from 2014-2015 provided an additional 225 arthroplasties for evaluation.

Results

Out of the original 411 shoulder arthroplasties, 220 drains were used. There were a total of 6 hematomas noted (incidence of 1.4%): three patients in the drain group, three in the non-drain group. Of the patients who had a drain placed, only one required surgical drainage; the patient was on both Coumadin and Plavix for a mechanical heart valve. Two other hematomas were noted in the follow-up period and resolved without intervention. Of the patients without drain placement, three hematomas were noted in follow-up, one required aspiration in the clinic and one required surgical drainage, and one resolved without any intervention. For the second cohort, ten drains were used in cases of revision, coagulopathy, or excessive blood loss. Of this group two patients in the non- drain group developed hematomas and required surgical drainage: one immediately and one several weeks post op.

Conclusion

As only one patient from each from the original group required surgical drainage, the routine use of drains was deemed unnecessary for total shoulder arthroplasty. Several years later, a second cohort demonstrated similar low incidence of perioperative hematoma. Therefore, the routine use of drains is not indicated; however, for revision cases or patients with a history of anticoagulation therapy, use of drains may decrease the risk of post-operative hematoma formation.