Suction drainage in bipolar arthroplasty for hip fracture is standard 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.

A prospective randomized 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, preopérative 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 random selection, drainage was then installed or not. Outcome criteria were number of reopérations, hemoglobin level on D0, 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 (D0, D2, D5, D10).

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 D0 (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.

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.

Les auteurs ont mené une étude prospective randomisée afin de vérifier l'utilité d'un drainage postopératoire après arthroplastie scellée intermédiaire pour fracture du col du fémur. Quatre vingt-six patients ont été inclus dans le protocole : mise en place d'une prothèse intermédiaire scellée par voie postéro-latérale. Les critères de jugement étaient le nombre de reprises chirurgicales, le taux d'hémoglobine (mesuré à JO, J1, J2, J5, J10), le nombre de patients et le nombre de culots globulaires transfusés dans chaque groupe, enfin dans les suites opératoires immédiates, la température comme reflet d'un éventuel hématome (mesurée à J1, J2, J5, J10).

Nous n'avons constaté aucune différence statistiquement significative entre les deux groupes, pour chacun des critères, confirmant ainsi les données de la littérature. Nous recommandons donc de ne plus utiliser de drainage postopératoire systématique après mise en place d'une prothèse intermédiaire scellée pour le traitement d'une fracture du col du fémur.