Does Intramedullary Reaming in Total Knee Arthroplasty Increase Postoperative Bleeding? A Propensity Score-Matched...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Conflicting evidence exists regarding the impact of avoiding femoral medullary canal reaming during total knee arthroplasty (TKA) on blood loss.
• This study investigated whether omitting medullary canal reaming in TKA could decrease overall blood loss.

Purpose of the Study:

• To determine if avoiding medullary canal reaming during TKA surgery leads to reduced perioperative blood loss.
• To compare blood loss and transfusion requirements between TKA with and without femoral medullary canal reaming.

Main Methods:

• A propensity score-matched cohort study involving 349 patients undergoing TKA.
• Patients were divided into two groups: those undergoing TKA with femoral intramedullary rod reaming and those without (using computer-assisted surgery).
• Perioperative blood loss was the primary outcome, calculated using patient blood volume and hemoglobin level changes.

Main Results:

• No significant difference in perioperative blood loss was observed at 1, 3, and 7 days postoperatively between the reaming and non-reaming groups.
• The incidence of allogeneic blood transfusions and deep vein thrombosis (DVT) did not differ significantly between the two matched groups.

Conclusions:

• Femoral medullary canal reaming during TKA does not significantly impact postoperative blood loss.
• Surgeons can continue using conventional surgical techniques, such as intramedullary rods, without specialized instruments, even for high-risk patients.
• The study supports the use of familiar surgical approaches in TKA without compromising patient safety regarding blood loss or thromboembolic events.