Abstract
BackgroundThe Reamer–Irrigator–Aspirator system was initially developed to reduce fat embolism and thermic necrosis during reamed intramedullary nail fixation of femoral shaft fractures. Currently, this system is used in extended applications including accessing large volume of autologous bone graft, as alternative for iliac crest harvesting. Antegrade femoral bone graft harvesting using the Reamer-Irrigator-Aspirator system is considered the standard technique. The aim of our study is to evaluate the efficacy (bone graft volume) and the complications (blood loss, postoperative pain, and incidence of iatrogenic fractures) of the Reamer–Irrigator–Aspirator system through the retrograde femoral route in a series of patients with post-traumatic bone defects or nonunions.MethodsA non-controlled single center retrospective observational cohort study was conducted in a level1 trauma center to evaluate all patients who were treated using the RIA system. Between November 2015 and May 2019, 24 patients (8 women and 16 men; mean age: 41 years [range 27–55 years]) with bone defects or nonunions underwent bone graft harvesting using the Reamer–Irrigator–Aspirator system through retrograde femoral route. Postoperative pain, complications, and bone graft volume were analyzed. Inclusion criteria was patients older than 18 years with a diagnosis of post-traumatic bone defect or associated tibial or femoral nonunion, with minimum 6-months follow, treated using the RIA. We hypothesized that the retrograde route of the RIA system is a safe and efficacious method for bone harvesting.ResultsThe average volume of collected graft was 45 cc (range 30–60 cc). In 83% of the cases, bone grafting was sufficient, while in 17% it was necessary to add iliac crest bone graft to completely fill the bone defect. A mean drop in postoperative hemoglobin of 4.1 g / dL (range 0.5–6.0 g / dL) was evidenced. In 4 cases (33%), a unit of packed red blood cells was required. Regarding postoperative pain, visual analogue scale after 3 months postoperatively was 1.6 in average. After 6 months, the value has decreased to 0.4. There were no perioperative or postoperative complications at 6-month follow-up.ConclusionIn this limited case series, large volumes of bone graft were harvested using the retrograde route of the RIA system and there were no intra-/ postoperative complications observed at 6-month follow-up. Therefore this novel technique appears safe and efficacious.However, it’s important to highlight that future prospective controlled studies are necessary to validate the insights from this pilot study.
Highlights
The Reamer–Irrigator–Aspirator (RIA; Synthes, West Chester, PA), initially developed to decrease thermal necrosis and the incidence of fat embolism during diaphyseal femur reaming, is routinely used for the treatment of long bone osteomyelitis, since it removes infected and necrotic bone from the medullary canal
It’s important to highlight that future prospective controlled studies are necessary to validate the insights from this pilot study
Especially in the last decade, it has become a helpful alternative to the classic iliac crest bone graft harvesting, since it offers a larger volume of bone graft without the drawback of severe postoperative pain, which frequently accompanies the iliac crest bone graft harvesting [1,2,3,4]
Summary
The Reamer–Irrigator–Aspirator (RIA; Synthes, West Chester, PA), initially developed to decrease thermal necrosis and the incidence of fat embolism during diaphyseal femur reaming, is routinely used for the treatment of long bone osteomyelitis, since it removes infected and necrotic bone from the medullary canal. The aim of this study was to evaluate the efficacy (bone graft volume) and safety (blood loss, postoperative pain, and incidence of iatrogenic fracture) of the RIA system through the retrograde route in a case series of patients with bone defects. The Reamer–Irrigator–Aspirator system was initially developed to reduce fat embolism and thermic necrosis during reamed intramedullary nail fixation of femoral shaft fractures This system is used in extended applications including accessing large volume of autologous bone graft, as alternative for iliac crest harvesting. The aim of our study is to evaluate the efficacy (bone graft volume) and the complications (blood loss, postoperative pain, and incidence of iatrogenic fractures) of the Reamer–Irrigator–Aspirator system through the retrograde femoral route in a series of patients with post-traumatic bone defects or nonunions
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