Closed Negative Suction Drain Entrapment in Total Knee Arthroplasty: A Report on the Implications of a Broken Drain Based on the ChatGPT Outlook

Abstract

Total knee arthroplasty (TKA) has been the gold standard treatment for end stage arthritis of knee. The advancements in techniques have allowed successful outcomes. The use of closed negative suction drain in TKA has been controversial. Entrapment of a drain following TKA with a broken drain has been reported rarely though it has important implications. An obese 65-year-old female presented with painful bilateral knees. A clinic-radiological assessment confirmed an advanced grade osteoarthritis (OA). A single stage bilateral TKA was done. The use of closed negative suction drain for both knees was done as a routine protocol. The left knee drain got entrapped and an inadvertent pull due to abnormal positioning in flexed knee impinged and broke the drain. The right knee removal of drain on the second post-operative day was uneventful. A radiological assessment confirmed the position of the broken drain in left knee. A mini arthrotomy ensued with removal of the drain piece. Subsequent post-operative period was uneventful. The knee function recovered with painless full range of motion. There was no evidence of infection or implant loosening noted at a two-year follow-up. The generative text model ChatGPT (OpenAI, USA) was used to identify the implication with the use of drains in TKA. The use of drains remains controversial with no clear consensus on its regular use. The breakage of drain poses an immediate concern with need for wound revision and removal of foreign body. The long-term observation for any knee infection, stiffness or poor knee function needs monitoring. The early identification can prevent late symptomatology. The closed negative suction drain in our practice has become selective and presently has an infrequent use in TKA. An entrapment of a closed negative suction drain merits urgent measures. The remedial measures may ensure to preserve the knee joint function and maintain the ability to do activities of daily living.