***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omized study , 58 patients with primary cemented hip arthroplasty and 39 patients with primary cemented knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage . There was no difference in healing of the wounds , postoperative blood transfusions , complications , or range of motion . Although there was more soaked dressing requiring reinforcements in the groups without drainage , as a result of this study , we no longer use drains in uncomplicated cemented primary hip and knee arthroplasties for osteoarthritis Abstract A prospect i ve evaluation of 98 patients who had undergone a total hip or knee arthroplasty was conducted to assess the effect of postoperative suction drainage . Sixty-six patients undergoing elective total hip arthroplasty and 32 patients undergoing total knee replacement were r and omly allocated to undergo either suction drainage or no drainage of the wound . Statistical analysis of the results showed no difference in wound healing , severity of wound haematoma , postoperative blood transfusion requirement , range of motion and duration of the hospitalization between the two groups . We conclude that the use of closed suction drainage provides no apparent advantage after uncomplicated total hip or knee arthroplasty Purpose of the study Suction drainage in bipolar arthroplasty for hip fracture is st and ard procedure despite the lack of a solid scienfific basis . No study is reported in the literature demonstrating an advantage of systematic drainage . The aim of this work was to search for reasons why this conventional practice should be continued , Material and method es A prospect i ve r and omized stydt in a homogeneous consecutive group of patients hospitalized in our unit for hip fracture were included in the study from January 1995 through January 1999 . Among the 183 patients , 97 were excluded ( hemostasis disorders or anticoagulant treatment , multiple fractures , preoperative anemia with Hg < 9.5 g/dl , postponed operation ) . For the 86 included patients , the posterolateral Moore access was used to implant a sealed intermediary prosthesis . According to r and om selection , drainage was then installed or not . Outcome criteria were number of reoperations , hemoglobin level on DO , D1 , D2 , D5 , and D10 , number of patients requiring transfusion and number of packed red cell units in each group , and finally , temperature as reflecting presence of possible hematome ( DO , D2 , D5 , D10 ) . Results The two groups were similar for age and sex . There were no reoperations for hematoma or superficial infection and only one patient was reoperated for early dislocation in the group without drainage . Twenty-seven patients had transfusions , 14 in the drainage group and 13 in the no drainage group ; mean number of packed red cell units was 2 . Hemoglobin level fell similarly in the two groups in DO ( 2.1 versus 1.9 ) , D2 ( 2.5 versus 2.4 ) , D ( 2.7 versus 2.7 ) , D10 ( 2.4 versus 2.6 ) as did mean temperatures . Discussion We were thus unable to demonstrate any advantage of using suction drainage in bipolar arthroplasty for hip fracture when using more access . This is in agreement with reports in the literature . Exception the simplification of nursing care by not using drains , the cost savings can be considerable in light of the number of patients treated . We recommend that systematic use of suction drainage be discontinued in bipolar arhtroplasty for hip fracture The routine use of surgical drains in total hip arthroplasty remains controversial . They have not been shown to decrease the rate of wound infection significantly and can provide a retro grade route for it . Their use does not reduce the size or incidence of post-operative wound haematomas . This prospect i ve , r and omised study was design ed to evaluate the role of drains in routine total hip arthroplasty . We investigated 552 patients ( 577 hips ) undergoing unilateral or bilateral total hip arthroplasty who had been r and omised to either having a drain for 24 hours or  not having a drain . All patients followed st and ardised pre- , intra- , and post-operative regimes and were independently assessed using the Harris hip score before operation and at six , 18 and 36 months follow-up . The rate of superficial and deep infection was 2.9 % and 0.4 % , respectively , in the drained group and 4.8 % and 0.7 % , respectively in the undrained group . One patient in the undrained group had a haematoma which did not require drainage or transfusion . The rate of transfusion after operation in the drained group was significantly higher than for undrained procedures ( p < 0.042 ) . The use of a drain did not influence the post-operative levels of haemoglobin , the revision rates , Harris hip scores , the length of hospital stay or the incidence of thromboembolism . We conclude that drains provide no clear advantage at total hip arthroplasty , represent an additional cost , and expose patients to a higher risk of transfusion We report on a prospect i ve r and omized trial on the effect of wound drains on wound healing following surgery for proximal femoral fractures . One hundred and seventy-seven consecutive patients admitted to Queen 's Medical Centre Nottingham , undergoing AO dynamic hip screw ( DHS ) or hemiarthroplasty were r and omized whether or not to receive  wound drainage .  Wound healing was assessed in terms of ultrasound examination , the ASEPSIS wound score system and overt infection rates . All patients were followed up at 6 weeks and 6 months . Ultrasound examinations showed that drains were indeed ineffective in preventing haematoma formation , the first time this has been demonstrated objective ly . However , using drains failed to prevent late seroma formation . Patients who received wound drainage showed statistically better wound healing on the ASEPSIS wound scoring system and a reduced infection rate . The ASEPSIS scores on day 2 and 5 postoperatively proved an accurate predictor of poor wound healing . This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing , and strongly supports the use of wound drains In a r and omized clinical study on 40 intraarticular knee joint drainages the effect of a high vacuum , middle vacuum , low vacuum and suction free drainages were examined . The maximum of the volume that was drained had been in the group of the suction free drainages . Drains with a long period of suction had a minimum of evaluated ultrasonographic effusion in the knee joint . The group with high vacuum was obviously not as long as open as in the other groups . Thrombi in the drainages could be found in every group . This refers to the observation that the finding of adherent thrombi is related to the material the drain is made of . Adherent thrombi decrease the possibility of secretion , not adherent thrombi do not decrease suction volume . Referring to these results it is obvious that not the high-vacuum drainage is the matter of choice for intraarticular drains . The  suction-free drainages or drains with reduced vacuum have more advantages in respect to simple , secure and fast implantation and h and ling A prospect i ve study of thirty-eight patients ( seventy-six knees ) who had had a primary bilateral total knee replacement and twelve patients ( twenty-four hips ) who had had a primary bilateral total hip replacement was conducted to assess the effect of postoperative suction drainage on wound-healing . A suction drain was placed on each patient 's right operative wound , while no drains were used on the left . Otherwise , the same operative technique and method of closure were used in all wounds . Statistical analysis of the results showed no difference between the two sides with regard to the incidences of swelling or persistent drainage . Return of active function of the quadriceps and of range of motion of the knee in patients who had had a total knee replacement was also unaffected by the use of suction drains . We concluded that the routine use of suction drains for wounds is unnecessary after uncomplicated total joint arthroplasty One hundred fifteen consecutive patients undergoing TKR were divided into two groups to determine whether blood loss and transfusion in total knee replacement ( TKR ) using adrenaline with saline infiltration would be less than TKR with tourniquet and drain . Group 1 , composed of 60 patients , received 2.5 mg of 1:1000 adrenaline diluted in 500 mL of normal saline , which was infiltrated into the skin , subcutaneous tissues , and capsule before surgical incision . No tourniquets or postoperative drains were used . Group 2 , composed of 55 patients , had a tourniquet and postoperative drain . Thromboprophylaxis with low molecular weight heparin also was used . Pre- and postoperative hemoglobin , blood loss , hematocrit , and transfusion requirements were studied in both groups ; in group 2 , blood loss in the drains also was noted . Average preoperative hemoglobin and hematocrit in the two groups were 13.7 g/dL and 39.3 g/dL , respectively , and 13.5 % and 39 % , respectively . Average intraoperative blood loss was 290 mL in group 1 and 377.7 mL in group 2 ( P<.005 ) . Postoperative blood loss in group 1 was < 50 mL based on dressing soakage and 297.7 mL in group 2 ( P<.005 ) . Average postoperative hemoglobin and hematocrit in the two groups were 10.6 g/dL and 8.4 g/dL , respectively , and 35.4 % and 31.1 % , respectively . Transfusion rates were 3.3 % and 23.6 % , respectively ( P<.005 ) . The average volume transfused was 1.2 U. Adrenaline and saline infiltration is safe and helps reduce intraoperative blood loss .  Suction drain use for surgical wounds after primary , uncomplicated TKR is question able The goal of this study is to report our experience with the use of suction drainage for various arthroscopic knee procedures . One hundred and ninety patients who underwent arthroscopic knee procedures participated in the study , and were divided into two groups ( Group 1 : Suction drainage , Group 2 : No suction drainage ) . For every patient , the following parameters were recorded : age , gender , operative time , tourniquet or pump use , the amount of fluid collected in the hemovac drain , presence of meniscal tear , type of the operative procedure , date of the operation , and presence of effusion at the follow-up . Statistical analysis was performed to detect any significant statistical difference between the amount of fluid collected in the hemovac drain and the other mentioned parameters in Group 1 ; and these patients were divided into four subgroups to facilitate the statistical evaluation between the procedures and the amount of fluid collected in the hemovac drain . The partial meniscectomy subgroup had significantly lower amounts of collected fluid when compared to the subtotal meniscectomy subgroup . Drilling of the osteochondral faces led to significantly higher amounts of fluid when compared to non-drilling cases . Use of an infusion pump during surgery and shorter operation time led to lower amounts of fluid to be collected . No case in either main group suffered from effusion at the follow-up . Our investigation demonstrated that in different arthroscopic interventions , variable amounts of fluid can be collected in the hemovac drains . Subtotal meniscal resection , drilling of the osteochondral faces and longer duration of the operation increase the amount of fluid . In cases of partial meniscal resection and /or chondral debridement , limited synovial and plica resection , suction drainage is unnecessary A r and omized , controlled study compared the effects of wound compression with drainage after primary total hip arthroplasty . In 51 patients , an inflatable cuff was placed over the wound underneath a girdle ( System Calmed , Calmed AB , Askim , Sweden ) . Control patients had wound drainage ( n = 54 ) . Preoperative and intraoperative variables did not differ between groups . Total blood loss was calculated using hemoglobin balance ; with compression it was 1510 + /- 656 mL ( mean + /- SD ) and in controls 1695 + /- 712 mL ( P = .13 ) . However , less blood was transfused in the compression group ( P = .05 ) . Wound infection was seen in 2 patients with compression and in 3 controls . Deep venous thrombosis occurred in 3 controls . Wound discharge was more frequent in controls ( 19/54 vs 8/51 ; P = .04 ) . Thus , wound compression had no obvious negative effects and reduced wound discharge and need for transfusion . It may replace drainage after total hip arthroplasty A prospect i ve , r and omized study was performed to assess the effectiveness of postoperative closed suction drainage .  One hundred and twelve consecutive procedures involving autologous iliac-crest bone graft were performed , from December 29 , 1992 , to July 1 , 1993 , following a traumatic injury of the spine in 108 patients . Sixty of the sites from which the bone graft had been obtained were drained with a single large Hemovac device . The drains were maintained for two to five days postoperatively . The remaining fifty-two incisions were closed without a drainage device . All patients were evaluated clinical ly for problems with wound-healing . The incisions were considered to be healed when they had been asymptomatic for one year . Of eleven patients who had problems with  wound-healing , six had been managed with a drain and five had not . The findings of this study do not support 
    Output:
    
Pooling of results indicated no statistically significant difference in the incidence of wound infection , haematoma , dehiscence or re-operations between those allocated to drains and the un-drained wounds .
Blood transfusion was required more frequently in those who received drains .
The need for reinforcement of wound dressings and the occurrence of bruising were more common in the group without drains .
There is insufficient evidence from r and omised trials to support the routine use of closed suction drainage  in orthopaedic surgery .