Association of different hemovac drainage management protocols on hemoglobin decrease, drainage volume, and blood transfusion requirements in total knee and hip arthroplasty: A retrospective cohort study

To examine whether the modified Hemovac protocol—which involves a 16-hour delay in negative-pressure activation and the application of intermittent temporary passive drainage—differs from immediate continuous negative-pressure drainage regarding early blood-loss-related outcomes and wound findings following primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Medical records of 200 patients who underwent primary TKA (n = 100) or THA (n = 100) between January 14, 2002, and December 20, 2007, were reviewed retrospectively. Within each arthroplasty type, 50 patients received immediate continuous negative-pressure drainage for the first 24 postoperative hours and 50 underwent a modified protocol in which negative-pressure activation was delayed for the first 16 hours, intermittent temporary passive drainage was applied during this period, and the drain was activated under negative pressure at the 16th hour. The analysis included preoperative and postoperative day 3 hemoglobin, hemoglobin decline, 24-hour drainage volume, allogeneic red blood cell transfusion, hospital stay, wound-site ecchymosis, and wound leakage. Baseline demographic and clinical characteristics were comparable between the drain-protocol groups within both arthroplasty types (all p > 0.05). The modified protocol was associated with a higher postoperative day 3 hemoglobin level and a smaller hemoglobin decline in both TKA and THA (all p < 0.001). Patients in the modified groups also had lower 24-hour drainage volumes, fewer transfusions, fewer transfused red blood cell units, and shorter hospital stays (all p < 0.05). Wound-site ecchymosis was less frequent with the modified protocol in TKA (p = 0.003), whereas no statistically significant difference was observed in THA (p = 0.081). Wound leakage did not differ significantly between protocols in either TKA (p = 0.050) or THA (p = 0.715). In this retrospective cohort, delayed Hemovac activation was associated with less postoperative drainage, a smaller decrease in hemoglobin, and lower transfusion use after both TKA and THA. The protocol was not associated with a higher frequency of wound leakage. Prospective studies conducted within contemporary blood-management pathways are needed to confirm these findings.