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Drainage after total knee replacement

Published online by Cambridge University Press:  17 February 2009

G. Sterling ,
G. D. McBain ,
J. A. Harris  and
M. Boland
G. Sterling
Affiliation:
Department of Orthopædics, Townsville General Hospital, Townsville, QLD, Australia.
G. D. McBain
Affiliation:
School of Aerospace, Mechanical, and Mechatronic Engineering, The University of Sydney, NSW, Australia.
J. A. Harris
Affiliation:
Maunsell Australia Pty Ltd, 21 Stokes St, Townsville QLD, Australia.
M. Boland
Affiliation:
Department of Orthopædics, Townsville General Hospital, Townsville, QLD, Australia.
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Abstract

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A simple lumped hydraulic model of knee drainage following arthroplasty is developed incorporating a pressure-volume equation of state for the knee capsule and a wound healing rate dynamically retarded by the blood flow-induced shear stress. The resulting second-order nonlinear ordinary differential system is examined numerically and qualitatively to map the parameter space. In the model, moderate suction or a slight back-pressure promotes gradual drainage and healing whereas excessive suction can lead to a bifurcation in which healing is retarded or even prevented. Guided, then, by the model, the literature, and experience, continuous drainage with a small constant back-pressure appeared beneficial so we prospectively evaluated a series of ten patients. The results are consistent with the model and promising.

Keywords

wound bleedingwound healingblood-flow shear-retarded healingnonlinear ordinary diffrential systemphase plane analysis

Information

Type
Research Article
Information
The ANZIAM Journal , Volume 48 , Issue 2 , October 2006 , pp. 199 - 210
Copyright
Copyright © Australian Mathematical Society 2006

References

[1]Adalberth, G., Bystrom, S., Kolstad, K., Mallmin, H. and Milbrink, J., “Post-operative drainage of knee arthroplasty is not necessary”, Acta Orthop. Scand. 69 (5) (1998) 475–78.CrossRefGoogle Scholar
[2]Beer, K. J., Lombardi, A. V., Mallory, T. H. and Vaughn, P. K., “The efficacy of suction drains after routine total joint arthroplasty” J. Bone Joint Surg. Am. 73 (1991) 584–587.CrossRefGoogle ScholarPubMed
[3]Benoni, G. and Fredin, H., “Low- or high-vacuum drains in hip arthroplasty?”, Acta Orthop. Scand. 68 (2) (1997) 133–137.CrossRefGoogle ScholarPubMed
[4]Berger, S. A. and Jou, L. D., “Flows in stenotic vessels” Ann. Rev. Fluid Mech. 32 (2000) 347–382.CrossRefGoogle Scholar
[5]Berman, A. T., Fabiano, D., Basacco, S. J. and Weiss, A. A., “Comparison between intermittent (spring-loaded) and continuous closed suction drainage of orthopedic wounds: A controlled clinical trial”, Orthopedics 13 (3) (1990) 309–314.CrossRefGoogle ScholarPubMed
[6]Drinkwater, C. J. and Neil, M. J., “Optimal timing of wound drain removal following total joint arthroplasty”, J. Arthroplasty 10 (2) (1995) 185–189.CrossRefGoogle ScholarPubMed
[7]Eaton, J. W., GNU Octave Manual (Network Theory, 2002).Google Scholar
[8]Geborek, P., Moritz, U. and Wollheim, F. A., “Joint capsular stiffness in knee arthritis, relationship to intraarticular volume, hydrostatic pressures and extensor muscle function” J. Rheumatol. 16 (1989) 1351–1358.Google ScholarPubMed
[9]Gopinath, P. and Arun, B., “Surgical exposures for primary total knee replacement”, J. Orthop. 1 (1) (2004) e6.Google Scholar
[10]Hindmarsh, A. C., “ODEPACK, a systematized collection of ODE solvers”, in Scientific Computing (ed. Stepleman, R. S.), (North-Holland, Amsterdam, 1983), 55–64.Google Scholar
[11]Holt, B. J., Parks, N. L., Engh, G. A. and Lawrence, J. M., “Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty”, Orthopedics 20 (12) (1997) 1121–1125.CrossRefGoogle ScholarPubMed
[12]Kim, Y. H., Cho, S. H. and Kim, R. S., “Drainage versus nondrainage in simultaneous bilateral total knee arthroplastics” Clin. Orthop. 347 (1998) 188–193.CrossRefGoogle Scholar
[13]Lamb, H., Hydrodynamics, 6th ed. (Cambridge University Press, Cambridge, 1932).Google Scholar
[14]Loder, P. B., Smith, G. H., Morris, S., Bambach, C. P. and Smith, R. C., “A randomised comparison of three drainage systems following cholecystectomy” Aust. N. Z. J. Surg. 57 (1987) 531–535.CrossRefGoogle ScholarPubMed
[15]Murray, J. D., Mathematical Biology (Springer, Berlin, 1989).CrossRefGoogle Scholar
[16]Ovadia, D., Luger, E., Bickels, J., Menachem, A. and Dekel, S., “Efficacy of closed wound drainage after total joint arthroplasty”, J. Arthroplasty 12 (3) (1997) 317–321.CrossRefGoogle ScholarPubMed
[17]Parker, M. J., Roberts, C. P. and Hay, D., “Closed suction drainage for hip and knee arthroplasty”, J. Bone Joint Surg. Am. 86 (6) (2004) 1146–1152.CrossRefGoogle ScholarPubMed
[18]Raves, H. J., Slifkin, M. and Diamond, D. L., “A bacteriologic study comparing closed suction and simple conduit drainage” Am. J. Surg. 148 (1984) 618–620.CrossRefGoogle ScholarPubMed
[19]Ritter, M. A., Keating, E. M. and Faris, P. M., “Closed wound drainage in total hip or total knee replacement”, J. Bone Joint Surg. Am. 76 (1994) 35–38.CrossRefGoogle ScholarPubMed
[20]Snowden, J. M., “Wound contraction: A quantitative interpretation”, Aust. J. Exp. Biol. Med. Sci. 59 (2) (1981) 203–217.CrossRefGoogle ScholarPubMed
[21]Sperber, A. and Wredmark, T., “Tensile properties of the knee joint capsule at elevated intra-articular pressure”, Acta Orthop. Scand. 69 (5) (1998) 484–488.CrossRefGoogle Scholar
[22]Zamora-Navas, P., Collada-Torres, F. and de la Torre-Solis, F., “Closed suction drainage after total knee arthroplasty”, Acta Orthopædica Belgica 65 (1) (1999) 44–47.Google Scholar