Most people do not have a drain after hip replacement surgery. The majority of orthopedic surgeons have moved away from routine drain use, and a large systematic review of 16 clinical trials found that 13 recommended against placing drains as standard practice. The current evidence shows that drains offer no clear advantage over skipping them entirely. That said, some surgeons still use them in specific situations, so it’s worth understanding what to expect either way.
Why Most Surgeons Skip the Drain
For decades, a small plastic tube connected to a suction bulb was placed near the hip incision before closing. The idea was to prevent blood and fluid from pooling around the new joint. But clinical trials comparing patients with and without drains have consistently found no meaningful difference in infection rates or hematoma complications. In one study comparing the two approaches, transfusion needs were nearly identical: 9.6% in the no-drain group versus 8.2% in the drain group.
What the research did find is that drains can increase the chance of needing a blood transfusion in some settings and may extend hospital stays. Since the drain itself provides an opening in the skin, it creates a potential pathway for bacteria to reach the joint. Given the lack of benefit and these small added risks, the trend over the past decade has firmly shifted toward no-drain protocols.
When a Drain Might Still Be Used
Your surgeon may decide a drain is appropriate based on factors specific to your case. People on blood-thinning medications, those with bleeding disorders, or patients undergoing revision surgery (a second operation on the same hip) sometimes receive a drain as a precaution. Surgeons who encounter more bleeding than expected during the procedure may also place one before closing.
If a drain is used, it’s typically a closed-suction type: a thin tube that exits through a small puncture near the incision and connects to a soft, squeezable bulb that creates gentle vacuum pressure. A less common option is a reinfusion drain, which collects your own blood so it can be filtered and returned to you through an IV. Research comparing these approaches found similar outcomes in terms of pain, hospital stay, and complication rates.
What Having a Drain Feels Like
If you do end up with a drain, you’ll notice a thin tube coming out of the skin near your hip connected to a small bulb, roughly the size of a grenade. The bulb collects fluid that ranges from dark red immediately after surgery to a lighter pink or straw color over the following days. Most drains placed after joint replacement are removed before you leave the hospital, typically within 24 to 48 hours. The general guideline is removal once output drops below about 25 milliliters per day for two consecutive days.
Removal itself is quick. A nurse or surgeon pulls the tube out in one smooth motion. Studies measuring pain during drain removal in joint replacement patients found average pain scores of about 3.7 out of 10 without any distraction techniques. With a simple trick like coughing at the moment of removal, that dropped to about 1.6 out of 10. The whole process takes only a few seconds.
If You Go Home With a Drain
In rare cases, a drain stays in place at discharge. If this happens, your surgical team will show you how to care for it before you leave. The basic routine involves emptying the bulb two to three times a day, measuring the fluid output, and re-squeezing the bulb flat to restore suction. You’ll also need to clear any small clots from the tubing each time, a process sometimes called “stripping” or “milking” the line.
Keep the area around the tube clean and dry. Contact your surgeon if the drainage turns cloudy, smells unusual, or increases in volume after it had been tapering off. These can be signs of infection developing at the drain site.
Persistent Wound Drainage Without a Drain
Even without a surgical drain, some oozing from the incision itself is normal for the first day or two. What matters is how quickly it stops. Persistent wound drainage, meaning fluid that continues leaking from the incision beyond the first few days, is a significant risk factor for deep joint infection. Research found that patients with persistent drainage had roughly 17 times the odds of developing an infection around the new joint compared to those whose incisions dried up on schedule.
Each additional day of ongoing drainage carries about a 29% increased risk of wound infection. If your incision is still actively wet three to five days after surgery, that warrants a call to your surgical team. In most cases, a brief period of wound care or a special dressing that applies gentle suction over the incision can help resolve it. The general guideline is that if drainage hasn’t stopped within seven days, more active intervention is usually considered.
How No-Drain Protocols Affect Recovery
Skipping the drain has practical benefits for your recovery timeline. Without tubing attached to your hip, you can get up and move more freely on the day of surgery or the morning after. Early mobilization is one of the strongest predictors of a smooth recovery after hip replacement, and not having a drain simplifies that first walk to the bathroom or down the hallway with a physical therapist.
Medications that reduce surgical bleeding have also made drains less necessary. A clot-stabilizing medication now given routinely during hip replacement surgery significantly reduces total blood loss, which was one of the original reasons drains were placed. With less bleeding at the surgical site, there’s simply less fluid that needs to be removed.
The no-drain group in studies does tend to develop slightly larger fluid collections around the joint on imaging. But these collections don’t translate into worse outcomes, more pain, or higher infection rates. The body reabsorbs this fluid on its own within a few weeks.