Background: The role of wound drainage after total knee arthroplasty is still considered controversial as although
closed drainage systems have been believed to be effective in decreasing the post-operative complications, they could
also facilitate the bleeding and increase the rate of transfusion and infection. We have conducted the current study to
compare the outcomes superficial subcutaneous, one deep, and two deep drain techniques after total knee arthroplasty.
Methods: Between 2014 and 2015 sixty consecutive patients were prospectively selected and underwent primary
total knee arthroplasty. Patients randomized to receive one superficial, one deep and two deep drains at the end of
operation. Tourniquet was used and opened at the end of the surgery after dressing. Patients were studied for volume
of blood loss, hemoglobin drop, number of transfusion, and any complications. Knee range of motion and diameter
were measured and compared with contralateral side in all cases at the end of the third day.
Results: There was no statistical difference regarding red blood cell volume loss, Hb drop, and transfusion rate between
groups. Patients in one superficial group had the most sever post-operative ecchymosis. Knee flexion and swelling
were the same in all groups. Patients in one superficial drain group had the worst VAS for the pain. Need for early
blood transfusion was significantly higher in two deep drain group. In one deep drain group returned back to operating
room for sever hemarthrosis and wound dehiscence was occurred in a patient. One patient in one deep group had also
developed mild thrombo-emboli.
Conclusion: Regarding the blood volume loss after total knee arthroplasty there is no difference between
superficial drainage and even more effective intra-articular techniques. Outcome and complication rates are the