Intramedullary sealing with a bone plug in total knee arthroplasty to reduce blood loss: a meta-analysis of randomized c
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(2019) 14:96
SYSTEMATIC REVIEW
Open Access
Intramedullary sealing with a bone plug in total knee arthroplasty to reduce blood loss: a meta-analysis of randomized controlled trials Varah Yuenyongviwat* , Pakjai Tuntarattanapong, Khanin Iamthanaporn, Theerawit Hongnaparak and Boonsin Tangtrakulwanich
Abstract Background: An intramedullary guide is an instrument that surgeons use to align the distal femoral cut. The opening may become a channel that drains intramedullary blood to the knee joint after surgery if left open during surgery. The authors aimed to evaluate the effects of an intramedullary bone plug with respect to postoperative blood loss from a meta-analysis. Methods: The authors performed a systematic review and meta-analysis to compare a sealed opening using an intramedullary bone plug with no bone plug. PubMed, Ovid, Embase, and Cochrane Library were used to identify all publications before May 2018. All of the included studies were evaluated for bias and heterogeneity. Results: Six hundred and thirty-six patients from four randomized controlled trials were included in this meta-analysis. The pooled results demonstrated that patients with intramedullary plug had lower rates of blood transfusion and lower level of reduced postoperative hemoglobin than patients in whom the intramedullary canal was not plugged. Discussion: This meta-analysis demonstrated the benefit of intramedullary sealing with a bone plug in total knee arthroplasty with respect to decreased postoperative blood loss. Keywords: Intramedullary sealing, Bone plug, Total knee arthroplasty
Background Decreasing the blood loss and transfusion rate may decrease postoperative complications after total knee arthroplasty (TKA) [1]. Many methods have been mentioned to decrease blood loss during and after TKA, such as tranexamic acid [2], fibrin sealant [3], and positioning of knee flexion after surgery [4]. An intramedullary guide is an instrument used by surgeons to align the distal femoral cut. The drawback of this instrument is the necessity to penetrate the intramedullary canal from the distal femur that leaves an opening at the distal femur. This opening can be a channel that allows drainage of intramedullary blood to the knee joint after surgery if left open during surgery. Many studies claimed * Correspondence: [email protected] Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
that sealing the intramedullary opening with a bone plug can decrease postoperative bleeding [5–8]. However, another study reported that sealing the intramedullary opening did not decrease blood loss or blood transfusion [9]. Due to the variety of results of available evidence, the authors aim to evaluate the effects of intramedullary sealing with a bone plug compared with leaving the opening open by a meta-analysis. The primary aim was to evaluate the transfusion rate, level of hemoglobin reduction, and drain volume.
Methods Database search and search strategy
This systematic review and meta-anal
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