Strong evidence supports not using a drain with total knee arthroplasty (TKA) because there is no difference in complications or outcomes.

Rationale
Four high-quality studies and three moderate-quality studies were reviewed.  These studies showed no difference in multiple measures including VTE, infection, swelling, blood transfusions, hematoma formation, range of motion, length of stay, pain or reoperation between the treatment groups.  One high quality study demonstrated a significantly greater need for manipulation (8 % vs. 0 %, P-value<0.05) in patients who did not receive a drain (Esler, 2003). Two high-quality studies reported significantly higher transfusion rates in patients who received a drain (Esler, 2003 and Li 2011).  Two high-quality studies found no difference in transfusion rates in the presence or absence of a drain (Ritter 1994 and Jenny 2001).  Meta-analysis of the included studies did not show significant differences in infection or flexion range of motion in the presence or absence of a drain.  One study (Niskanen 2000) suggested that there may be more wound drainage in patients without a drain.  All studies were relatively small ranging from 20 – 50 patients per treatment group with the exception of one high-quality study with 138 patients per treatment group (Ritter 1994).
  1. Esler,C.N.A., Blakeway,C., Fiddian,N.J. The use of a closed-suction drain in total knee arthroplasty. Journal of Bone and Joint Surgery - Series B 2003; 2: 215-217
  2. Jenny,J.Y., Boeri,C., Lafare,S. No drainage does not increase complication risk after total knee prosthesis implantation: a prospective, comparative, randomized study. Knee Surg Sports Traumatol.Arthrosc. 2001/9; 5: 299-301
  3. Li,C., Nijat,A., Askar,M. No clear advantage to use of wound drains after unilateral total knee arthroplasty: a prospective randomized, controlled trial. J Arthroplasty 2011/6; 4: 519-522
  4. Niskanen,R.O., Korkala,O.L., Haapala,J., Kuokkanen,H.O., Kaukonen,J.P., Salo,S.A. Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplasty 2000/8; 5: 567-569
  5. Ritter,M.A., Keating,E.M., Faris,P.M. Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. J Bone Joint Surg Am 1994/1; 1: 35-38