Technique and indications for the retrograde use of the reamer-irrigator-aspirator

Abstract

Background: The reamer-irrigator-aspirator (RIA; Depuy-Synthes, West Chester PA) is an industry-developed device that was developed to diminish the theoretical risks to the cardiopulmonary and skeletal system during intramedullary reaming. The indications for use of the RIA have been greatly expanded over the past decade to include debridement of medullary osteomyelitis and large-volume autogenous bone-graft harvest. The manufacturer recommends using the RIA in an antegrade fashion to ream the femoral canal. The indications for retrograde RIA have not been discussed in the literature previously. The purpose of this study is to describe the indications used for a small series of patients treated with retrograde RIA for autogenous bone graft harvest. Methods: This is a retrospective case series of three patients in whom a large volume of autogenous bone graft was obtained using the reamer-irrigator-aspirator in a retrograde fashion, a method that has not been previously reported. Results: The retrograde use of the reamer-irrigator-aspirator was a safe and effective method of obtaining an average of 37 cc of autogenous bone graft in a carefully selected small group of patients with segmental bone loss, nonunion, and obesity. Conclusions: The indications for retrograde use of the RIA device have not been previously reported in the orthopaedic literature. Our study suggests the following indications for retrograde RIA use: obesity, “violated joint” concept, and locally compromised tissue preventing antegrade reaming. Hemarthrosis within the knee is prevented by impaction of an allograft bone dowel into the reamer entry site.