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Femoral Reaming: for THR

- Discussion:
    - goal: ream close to endosteal cortex, which has strongest cancellous bone;
    - enter medullary canal w/ curet, & ensure that there are no perforations;
            - this is esp important w/ osteoporotic bone;
    - to enlarge medullary canal of diaphysis, use of medullary nail reamers may be necessary;
            - if rasp is used for this purpose, risk of femoral fracture is high; the rasp will act as a wedge to split the femur;
    - similarly, it is important to determine that the diameter of the stem is the same as the diameter of the medullary reamer;
    - for press fit, it is advisable to ream a canal 0.5 to 1.0 mm > stem;
    - in general, for cement fixation of the stem, the extent of reaming is such that most of the cancellous bone is removed and the cement is fixed to cortical bone;
    - the first reamer is introduced by hand to ensure that the back cut is large enough and that the canal is open;
            - this reamer should not touch the bone around the back cut;
    - reaming should stop once the cortex is felt;
    - previous templating will give a fairly clear idea of the expected size
    - if the reamer begins to touch cortex at a much smaller size than expected, then the reamer is in a varus orientation;
            - the back cut should then be enlarged and the canal rereamed

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