 Patients scheduled to undergo total knee replacement surgery will be randomized to receive reaming with either the Synthes RIA intervention group or standard reamer control group. All subjects will undergo intraoperative monitoring with transesophageal echocardiography and transcranial Doppler ultrasound. Both intraoperative and postoperative oxygen saturation levels will be monitored and recorded for evidence of hypoxemia. Subjects will be evaluated for evidence of thrombogenesis and systemic inflammation both preoperatively and at selected postoperative intervals. 