***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 The purpose of this prospect i ve study was to analyze the biochemical markers of muscle damage and inflammation in patients treated with the mini-midvastus approach or the medial parapatellar approach for total knee arthroplasty . Of 60 patients who underwent unilateral total knee arthroplasty , 30 were treated with the mini-midvastus approach ( MMV group ) and 30 were treated with the  medial parapatellar approach ( MPP group ) . Serum creatine kinase , myoglobin , lactate dehydrogenase , glutamic oxaloacetic transaminase , C-reactive protein , interleukin-6 , and interleukin-1β levels were measured preoperatively , immediately postoperatively ( except for C-reactive protein level ) , and on postoperative days 1 , 2 , and 3 . Student 's t test , Pearson 's chi-square test , and Fisher 's exact test were used to compare the outcomes between the 2 groups . Compared with the MPP group , a significant increase in serum creatine kinase level existed in the MMV group on postoperative days 2 ( P=.08 ) and 3 ( P=.09 ) and cumulatively ( P=.02 ) . However , significantly elevated C-reactive protein and interleukin-6 levels existed in the MPP group . According to the serum creatine kinase levels , the mini-midvastus approach has no superiority over the medial parapatellar approach in terms of sparing muscle and may cause more muscle damage . Further study is warranted to determine the correlation between biochemical markers and functional deficits Closed suction drains reduce postoperative hematoma formation , but create an entry portal for bacteria and thus increase the risk of infection . This study attempts to establish when the risks of wound drainage outweigh the benefits . In a prospect i ve clinical trial , wound drains were used in all patients having a total knee or total hip arthroplasty . Timing of drain removal and amount drained were recorded . Drain-site swabs were sent with drain tips for bacteriology . Results suggest that the likelihood of bacterial colonization increases while wound drainage decreases with time . The authors conclude that the optimal time to remove drains is 24 hours after total joint arthroplasty Background : The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss , blood transfusion and no increase in complications compared to a routine continuous suction drainage system . This was a r and omized prospect i ve study on patients undergoing total knee arthroplasty Total knee arthroplasty is sometimes associated with major post-operative bleeding , often requiring transfusion . A prospect i ve , r and omised study was undertaken to assess the effect on post-operative bleeding of delaying release of the clamp on the suction drains . One hundred patients were allocated into two groups : Group A- immediate release of drain following release of tourniquet , and Group B- delayed release of the drain clamp by one hour . There was a statistically significant reduction ( p = < 0.001 ) in postoperative bleeding between group A ( 1050 ml ; 95%CI 728 - 1172 ml ) compared to group B ( 732 ml ; 95 % CI 620- 845 ml ) . Average drop in corrected haemoglobin and postoperative transfusion requirement were also less in the delayed group . The results show that delaying release of the drains by one hour reduces postoperative blood loss and transfusion requirement following total knee arthroplasty Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding . In a prospect i ve , r and omised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis . We compared blood loss , number of transfusions , postoperative complications and knee function and found significantly less postoperative blood loss through the drains ( p < 0.001 ) , and fewer blood transfusions ( p = 0.09 ) were needed in the clamped group . We conclude that clamping drainage after total knee arthroplasty in severe osteoarthritis reduces blood loss through the drains and the need for blood transfusions . RésuméLa prothèse totale du genou dans les gonarthroses sévères nécessite souvent une résection tissulaire importante , celle-ci étant souvent associée à un saignement important . Nous avons réalisé une étude prospect i ve r and omisée comparant le drainage conventionnel post-opératoire versus clampage du drain durant 4 heures chez 60 patients ayant bénéficié d’une prothèse totale du genou pour une gonarthrose importante . Nous avons comparé les pertes sanguines , le nombre de transfusion , les complications post-opératoires , la fonction du genou . Nous avons observé qu’il y avait beaucoup moins de pertes sanguines dans les drains ( p < 0.001 ) et beaucoup moins de transfusions ( p = 0.009 ) dans le groupe des patients do nt le drain avait été clampé pendant 4 heures . Nous pouvons conclure que le clampage du drain après prothèse totale du genou dans les gonarthroses sévères permet de réduire les pertes sanguines et le nombre de transfusions Background Total knee arthroplasty ( TKA ) is a common procedure that has a risk of significant blood loss and blood transfusion , and carries a substantial risk for immunologic reactions and disease transmission . Drain clamping is a popular method that is applied to reduce blood loss after TKA . However , the clamping protocol remains controversial . Therefore , we established a new protocol , 3-h interval clamping , and compared the bleeding control efficacy of this protocol following TKA with the non-clamping technique . Methods Between March and July 2008 , we enrolled 100 patients ( 100 knees ) who underwent uncomplicated TKA using a minimally invasive surgical technique . The patients were r and omly assigned into two groups based on the draining protocol : non-clamping ( group A ) and 3-h interval clamping ( group B ) . For group A , a vacuum drain was connected to a container and was run continuously during the first postoperative day , whereas the vacuum was stopped twice ( for ~3 h each time ) for group B. Demographic characteristics and clinical data were collected , including the levels of hemoglobin and hematocrit , the total blood loss volume , the number of patients who required a blood transfusion , and any complications that developed . The perioperative data were compared between the two groups . Results The drainage blood volume in the interval-clamping group ( group B ) was significantly lower than that in the non-clamping group ( group A ) during the first 48 h following the procedure ( p < 0.001 and p = 0.005 for first and second postoperative days , respectively ) . The mean fall in hemoglobin levels at 12 h in the interval-clamping group ( 2.8 ± 0.9 g/dL ) was also lower than in the non-clamping group ( 3.2 ± 0.8 g/dL ) . In the 3-h interval clamping protocol , the number of patients requiring a transfusion was 2.2 times less than the number in the non-clamping protocol , but was not significantly different ( odds ratio = 2.20 , p = 0.24 ) , and the significant predictor of blood transfusion was the preoperative hemoglobin level ( odds ratio = 7.73 , p < 0.001 ) . No wound infection or clinical venous thromboembolisms were detected in our study . Conclusion The 3-h interval clamping is a newly developed protocol for reducing blood loss after TKA . The protocol lessens the decrease in postoperative hemoglobin levels . This protocol can be applied easily without increasing clinical thromboembolic events and wound complications We prospect ively r and omized 415 total joint replacements for either a closed wound-drainage system or no postoperative drainage . Drainage was not used in 200 total joint replacements , of which 138 were total knee replacements and sixty-two , total hip replacements . Drainage was used in 215 total joint replacements , of which 137 were total knee replacements and seventy-eight , total hip replacements . All patients were evaluated for the presence of excessive postoperative drainage that necessitated cessation of the range-of-motion exercises , the amount of transfused blood ( homologous and autologous ) , and the preoperative and postoperative hemoglobin levels . The range of motion was assessed daily in the patients who had a total knee replacement . No statistical difference was found in the number of patients who had excessive postoperative drainage from a drained or non-drained wound . There was also no statistical difference with respect to the amount of transfused blood and the preoperative and postoperative hemoglobin levels . Furthermore , in the patients who had a total knee replacement , there were no statistical differences between drained and non-drained wounds with respect to the daily range of motion during the first seven days postoperatively . The mean amount of blood transfused was 157 milliliters in the total knee replacements with drains , 160 milliliters in the total knee replacements without drains , 188 milliliters in the total hip replacements with drains , and ninety-three milliliters in the total hip replacements without drains . ( ABSTRACT TRUNCATED AT 250 WORDS We undertook a prospect i ve , r and omised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with post-operative blood salvage in reducing blood loss in 212 total knee arthroplasties . The mean post-operative drained blood volume after drain clamping was 352.1 ml compared to 662.3 ml after blood salvage ( p < 0.0001 ) . Allogenic blood transfusion was needed in one patient in the drain group and for three in the blood salvage group . Drain clamping with intra-articular injection of saline with adrenaline is more effective than post-operative autologous blood transfusion in reducing blood loss during total knee arthroplasty We prospect ively studied the cases of 121 patients who were being operated on for insertion of a unilateral total knee prosthesis with cement , and we placed them r and omly in four groups . In Group I , the tourniquet was inflated throughout the operative procedure , and we released it postoperatively after a compressive dressing had been applied ; a splint was used postoperatively for three days . In Group II , the tourniquet remained inflated throughout the operation , but no splint was applied postoperatively , and continuous passive motion was started immediately in the recovery room . In Group III , the tourniquet was released intraoperatively , and hemostasis was achieved by cauterization ; postoperatively , a compressive dressing was applied , and a splint was used for three days . In Group IV , the tourniquet was released intraoperatively , hemostasis was established , and then the tourniquet was reinflated ; a compressive dressing was applied , and continuous passive motion was started immediately in the recovery room . Hemoglobin and hematocrit values were monitored in all patients . Blood loss in suction drainage was recorded , and the total blood loss was calculated . The results show that total knee arthroplasty is associated with major loss of blood ( mean , 1518 milliliters ) . The calculated blood loss for Groups I , II , and III averaged 1443 milliliters , while that for Group IV averaged 1793 milliliters . Loss in suction drainage correlated with total estimated blood loss and averaged 511 milliliters . The magnitude of blood loss after total knee arthroplasty should be appreciated , and special attention should be paid to the availability of adequate fluid and blood products , preferably blood donated by the patient preoperatively We prospect ively r and omised 100 patients undergoing cemented total knee replacement to receive either a single deep closed-suction drain or no drain . The total blood loss was significantly greater in those with a drain ( 568 ml versus 119 ml , p < 0.01 ; 95 % CI 360 to 520 ) although those without lost more blood into the dressings ( 55 ml versus 119 ml , p < 0.01 ; 95 % CI -70 to 10 ) . There was no statistical difference in the postoperative swelling or pain score , or in the incidence of pyrexia , ecchymosis , time at which flexion was regained or the need for manipulation , or in the incidence of infection at a minimum of five years after surgery in the two groups . We have been unable to provide evidence to support the use of a closed-suction drain in cemented knee arthroplasty . It merely interferes with mobilisation and complicates nursing . Reinfusion drains may , however , prove to be beneficial A prospect i ve r and om 
    Output:
    
The results indicate that temporary clamping could significantly reduce the drainage volume , including total drainage volume , drainage volume within 24 hours postoperatively , and drainage volume within 48 hours postoperatively .
Furthermore , patients treated with temporary drainage clamping for 4 hours or more had a higher hemoglobin level 24 hours postoperatively than the patients treated with no clamping , and the number of blood transfusions per patient decreased significantly .
No significant difference was identified between the 2 practice s regarding postoperative range of motion , wound-related complications , and deep vein thrombosis .