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Review
. 2019 Apr 8;14(1):96.
doi: 10.1186/s13018-019-1141-x.

Intramedullary sealing with a bone plug in total knee arthroplasty to reduce blood loss: a meta-analysis of randomized controlled trials

Varah Yuenyongviwat  1 , Pakjai Tuntarattanapong  2 , Khanin Iamthanaporn  2 , Theerawit Hongnaparak  2 , Boonsin Tangtrakulwanich  2
Affiliations
Review

Intramedullary sealing with a bone plug in total knee arthroplasty to reduce blood loss: a meta-analysis of randomized controlled trials

Varah Yuenyongviwat et al. J Orthop Surg Res. .

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: Bone plug; Intramedullary sealing; Total knee arthroplasty.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee and Institutional Review Board of the Faculty of Medicine, Prince of Songkla University.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Risk of bias assessment of the included RCT studies
Fig. 3
Fig. 3
Forest plot for transfusion rate
Fig. 4
Fig. 4
Forest plot for hemoglobin reduction
Fig. 5
Fig. 5
Forest plot of drain volume
See this image and copyright information in PMC

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References

    1. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty. 2004;19:281–287. doi: 10.1016/j.arth.2003.10.013. - DOI - PubMed
    1. Howes JP, Sharma V, Cohen AT. Tranexamic acid reduces blood loss after knee arthroplasty. J Bone Joint Surg [Br]. 1996;78-B:995–996. doi: 10.1302/0301-620X.78B6.0780995. - DOI - PubMed
    1. Wang GJ, Hungerford DS, Savory CG, Rosenberg AG, Mont MA, Burks SG, et al. Use of fibrin sealant to reduce bloody drainage and hemoglobin loss after total knee arthroplasty: a brief note on a randomized prospective trial. J Bone Joint Surg [Am] 2001;83-A(10):1503–1505. doi: 10.2106/00004623-200110000-00007. - DOI - PubMed
    1. Li B, Wen Y, Liu D, Tian L. The effect of knee position on blood loss and range of motion following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):594–599. doi: 10.1007/s00167-011-1628-4. - DOI - PubMed
    1. Li X, Qi XB, Han X, Wang W, Liu JN, Guo JC, et al. Effects of sealing the intramedullary femoral canal in total knee arthroplasty: a randomized study. Medicine (Baltimore). 2017;96(29):e7388. doi: 10.1097/MD.0000000000007388. - DOI - PMC - PubMed

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