Autogenous Bone Graft Harvesting Research Articles

Assessing donor site pain after Iliac Crest Bone Graft

Objective: The aim of the present study was to evaluate the intensity of donor site pain after autogenous iliac crest bone graft harvest for arthrodesis of joints and non-union of fractures.
 Methodology: This prospective cross-sectional study was conducted at the Orthopedics Department of Khalifa Gul Nawaz Teaching Hospital in Bannu. A total of 156 patients who underwent iliac crest bone graft harvest were included in the study. The frequency and intensity of donor site pain were assessed using the visual analogue scale (VAS) after one month of postoperatively.
 Results: Out of 156 patients, the majority were males (61.5%). The mean age and pain score observed in the enrolled patients was 34.7 ± 9.5 years and 2.24 ± 2.01, respectively. Mild pain was present at one-month follow-up postoperatively in 50.6% of the patients. The pain intensity was assessed in relation to gender and age; there was no significant difference in the mean VAS scores between males and females (p=0.45). Furthermore, stratification with respect to age also displayed no significant variation in the pain scores with respect to age (p=0.99).
 Conclusion: Donor site pain remains significant morbidity associated with iliac crest bone graft, mild pain was observed in half of the enrolled cases, and only 23% were pain-free after one month of the surgery.

Quality of Life Assessment and Co-Morbidities of Maxillofacial Surgery Department Patients Undergoing Iliac Crest Harvesting Procedures

Autogenous bone grafts are the gold standard for bone harvesting, namely the iliac crest. A retrospective, cross-sectional study was conducted, to assess the quality-of-life changes and donor site morbidity of patients who underwent anterior or posterior iliac crest autogenous bone graft harvesting procedures at King Abdulaziz University Hospital, using a survey instrument to obtain responses via phone call from 31 interviewed patients, mainly males (51.6%), with mean age of 36.77(17.1). Results

Patient's perception of recovery after sinus membrane elevation and blood coagulum compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral. Secondary outcomes from a single-blinded randomized controlled trial.

The objective was to assess patient's perception of recovery after maxillary sinus membrane elevation (MSME) and blood coagulum (test) compared with maxillary sinus floor augmentation (MSFA) and 1:1mixture of autogenous bone graft from the buccal antrostomy and deproteinized porcine bone mineral (DPBM) (control). Forty healthy patients were randomly allocated to test or control. Oral health-related quality of life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment and 1week postsurgical. Recovery was estimated by questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, and discomfort after 1week and 1month. Mean differences were expressed with 95% confidence interval (CI). Association between OHRQoL and recovery was estimated. p-value below .05 was considered statistically significant. Maxillary sinus membrane elevation revealed 2.1less days of pain (p=.03, 95% CI: 0.2-4.1) and 1.2days of sick leave (p=.01, 95% CI: 0.3-2.1) compared with MSFA. No significant difference was observed in eating and speaking ability, physical appearance, work performance, and sleep impairment. No significant association between impaired OHRQoL and recovery was observed. Females reported 4.77higher OHIP-14score compared with males (p=.01, 95% CI: 1.60-7.94), while association between age and OHIP-14 was -0.10 (p=.28, 95% CI: -0.28 to 0.08). Maxillary sinus membrane elevation revealed significantly less days of pain and sick leave compared with MSFA. Harvesting of autogenous bone graft seems, therefore, to have a significant impact on perception of recovery.

Patient\u2019s perception of recovery after maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: a single-blinded randomized controlled trial

BackgroundAutogenous bone graft is considered as the preferred grafting material for maxillary sinus floor augmentation (MSFA). However, harvesting of extraoral or intraoral autogenous bone graft is associated with risk of donor site morbidity and supplementary surgery. From a clinical and patient perspective, it would therefore be an advantage, if postoperative discomfort could be minimized by diminishing the need for autogenous bone graft harvesting. The objective of the present study was to test the hypothesis of no difference in patient’s perception of recovery after MSFA with autogenous bone graft from the zygomatic buttress (control) compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral (DPBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients were randomly allocated to either control or test groups. Oral Health-related Quality of Life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment. Recovery was estimated by self-administrated questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment and discomfort after 1 week and 1 month. Descriptive statistics was expressed as mean with standard deviation (SD). Correlation between OHRQoL at enrollment and recovery were assessed by linear regression. p-value below 0.05 was considered significant.ResultsTreatment satisfaction and willingness to undergo similar surgery were high in all groups. Average numbers of days with pain and sick leave were 3.5 (SD 3.9) and 0.5 (SD 1.2), respectively, with no significant difference between groups. Moreover, no significant difference in eating and speaking ability, physical appearance, work performance and sleep impairment were seen between groups. Mean OHIP-14 score at enrollment was 9.30 (SD 9.25) (control), 9.95 (SD 7.96) (Test I) and 8.15 (SD 9.37) (Test II), with no significant differences between groups. Impaired OHRQoL, gender or age seems not to predispose for delayed recovery or increased postoperative discomfort.ConclusionsMSFA with diminutive autogenous bone graft harvesting is associated with high patient satisfaction, limited postoperative discomfort and willingness to undergo similar surgery. Presurgical OHRQoL, gender or age seems not to be associated with impaired patient’s perception of recovery.

Bone quality and quantity of the mandibular symphyseal region in autogenous bone grafting using cone-beam computed tomography: a cross-sectional study

BackgroundBone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity and quality of bone in the mandibular symphysis for autogenous bone graft harvesting using cone-beam computed tomography (CBCT).MethodsThis cross-sectional study evaluated the CBCT scans of 78 adults presenting to three oral and maxillofacial radiology centers. The vertical (VD) and horizontal (HD) alveolar bone dimensions, cortical thickness (CT), and cancellous to cortical bone ratio (C/C) were measured in the interforaminal region of the mandible at the sites of central incisor to first premolar teeth. The interforaminal distance (ID) and the anterior loop length were also measured. Nonparametric statistical tests were used to analyze the data with respect to sex, age, and tooth position.ResultsThe median VD, HD, and CT of the symphysis were 20.21 (3.26), 4.13 (0.37), and 2.25 (0.23) mm, respectively. The median C/C was 1.51 (0.11). The median ID was 52.24 (8.24) mm, and the median anterior loop length was 1.82 (1.06) mm. Significant differences were observed in all parameters among different teeth. Most of the measured parameters were greater in males compared with females. There were significant differences in ID, VD, and CT between different age groups.ConclusionsThe quantity and quality of the available bone in the mandibular symphysis for bone graft harvesting vary by gender, age, and harvesting site, necessitating careful preoperative evaluation.

More weighted cancellous bone can be harvested from the proximal tibia with less donor site pain than anterior iliac crest corticocancellous bone harvesting: retrospective review

BackgroundIliac crest is the most preferred autogenous bone graft harvesting donor site while it has sorts of complications like prolonged pain, hematoma, and fracture. Harvesting cancellous bone from proximal tibia is also increasingly being used because of lower complications and less donor site pain. However, there are lack of studies to compare these two donor sites in detail. Thus, we proposed to investigate the available amount of autogenous bone graft from the proximal tibia.MethodsFifty-one patients who underwent simultaneous bone graft harvest from the PT and the AIC to fill up the given critical sized bone defects were enrolled in this study. We prospectively collected data including the weight of the harvested bone, donor site pain using the visual analog scale (VAS) score, and complications between the two sites.ResultsThe mean weight of cancellous bone harvested from the PT was greater than AIC (33.2g vs. 27.4g, p = 0.001). The mean VAS score was significantly lesser in the PT up to 60 days after harvesting (p < 0.001). There was persistent pain up to 90 days in four PT patients and in seven AIC patients. The major complication was reported only in AIC patients (11.8%).ConclusionsHarvesting cancellous bone from the PT is an acceptable alternative to the AIC for autogenous bone grafting owing to availability of more weighted graft bone and less donor site pain.

Harvesting of Autogenous Bone Graft from the Ascending Mandibular Ramus Compared with the Chin Region: a Systematic Review and Meta-Analysis Focusing on Complications and Donor Site Morbidity.

ABSTRACTObjectivesThe aim of this systematic review was to test the hypothesis of no difference in complications and donor site morbidity following harvesting of autogenous bone graft from the ascending mandibular ramus compared with the chin region.Material and MethodsMEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted including human studies published in English through June 26, 2020. Randomized and controlled trials were included. Outcome measures included pain, infection, mucosal dehiscence, altered sensation or vitality of adjacent tooth/teeth, neurosensory disturbances and patient-reported outcome measures. Risk of bias was assessed by Cochrane risk of bias tool and Newcastle-Ottawa Scale.ResultsTen controlled trials of high-quality fulfilled inclusion criteria. Risk of infection and mucosal dehiscence seems to be comparable with the two treatment modalities. However, harvesting from the chin seems to be associated with increased risk of pain, altered sensation or loss of tooth vitality, and neurosensory disturbances. Willingness to undergo the same treatment again was reported with both treatment modalities, but significant higher satisfaction, lower discomfort and acceptance of the surgical procedure was reported following harvesting from the ascending mandibular ramus.ConclusionsThe hypothesis was rejected due to higher prevalence and severity of complications and donor site morbidity following harvesting of autogenous bone graft from the chin region. Dissimilar evaluation methods and various methodological confounding factors posed serious restrictions for literature review in a quantitative systematic manner. Conclusions drawn from results of this systematic review should therefore be interpreted with caution.

STAND-ALONE PEEK CAGE FOR SINGLE LEVEL CERVICAL DISC DISEASE SHORT TERM RESULTS.

The Enthusiasm for Cervical cages in cervical fusion operations is an effort to avoid the morbidity associated with autogenous bone graft harvesting. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with hydroxyapatite granules in the treatment of single level disc affection. 19 patients affected by single-level cervical disc disease were included in this study. The clinical findings were assessed according to Odom’s criteria at last follow-up. Cervical spine segmental sagittal alignment was evaluated preoperative, direct postoperative and 12 months later. 19 patients underwent ACDF using a PEEK cervical cage. The clinical assessment according to Odom’s criteria after 12 months was excellent in 50%, good in 24% patients, fair in 11% and 15 poor clinical results. The mean segmental lordosis before surgery was 2°, corrected to - 6.6° immediately postoperative. The final mean segmental lordosis was 3.3°; the loss of correction was 3.5°. Anterior cervical discectomy and fusion using a stand-alone PEEK cage can be considered a safe and effective technique for the management of single level cervical disc disease.

Prospective evaluation of morbidity in patients who underwent autogenous bone-graft harvesting from the mandibular symphysis and retromolar regions.

Autogenous bone grafts are the most favorable and predictable types of bone graft due to their osteogenic, osteoinductive, and osteoconductive properties. The advantages of harvesting from mandibular bone are that it requires only local anesthesia, is less invasive, has less morbidity, and avoids harvesting from distant sites, thus making it the best choice for maxillary bone reconstruction. The aim of this study was to evaluate inferior alveolar nerve (IAN) neurosensory disturbances after autogenous bone graft harvesting from the mandibular symphysis and retromolar region to reconstruct maxillary sinus height for posterior dental implant placement and the effect of these disturbances on patient satisfaction. Fifty-four patients were invited to participate in this study. Autogenous bone graft was harvested from the mandibular symphysis and retromolar regions. After the procedure, the patients were evaluated by means of an adapted questionnaire to determine if they had complaints of neurosensory disturbances at the following time intervals: immediately, 1, 2-5, 6, 7-11, and 12 months postsurgery. Immediately after surgery, 28 patients described sensory changes and 25 reported paresthesia of inferior lip. Only three patients reported pain, and one patient experienced dental hypersensitivity after the surgical procedure. During the evaluation period, the patients reported a decrease in paresthesia and a return of sensation to areas innervated by the IAN. After 12 months, five patients still reported paresthesia of areas innervated by the IAN. Beside this, patients reported significant clinical improvement from the beginning of the evaluation, as 49 patients were satisfied with their treatment outcomes. Harvesting bone grafts from the mandibular symphysis results in greater postoperative morbidity upon immediate evaluation compared with bone graft harvesting from the retromolar region. Nevertheless, during clinical follow-up, the results of both treatments showed that sensation was eventually recovered, depending on the healing period.

The Effects of Maxillary Expansion on Late Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

The purpose of this study was to answer the research question of whether maxillary expansion provides enough postgraft stimulation to decrease the volume loss of alveolar bone grafts in patients with cleft lip and palate (CLP) who missed the appropriate treatment time. This study was designed as a prospective controlled clinical trial. Thirty patients in the permanent-dentition stage with unilateral CLP were divided into 2 groups: In group I (mean age, 19.33±5.16years), slow maxillary expansion was performed before secondary alveolar bone grafting (SABG); in group II (mean age, 19.93±3.99years), slow maxillary expansion was performed 6weeks after SABG. The iliac crest was preferred as a donor site for autogenous bone graft harvesting. Cone beam computed tomography images were taken 1week, 6months, and 12months postoperatively. The volume and density of the alveolar bone graft were calculated using Mimics software (version 13.1; Materialise, Ann Arbor, MI), and SPSS software (version 19.0; IBM, Armonk, NY) was used for statistical analysis. The bone graft volume loss was significantly higher in group I than in group II after 6months of healing (P=.003). The increase in bone density was significantly higher in group II than in group I after 6months of healing (P=.017). Although the mean loss of volume was lower and the mean density of the bone graft was higher in group II, there was no significant difference between the 2 groups in terms of mean graft volume and mean bone density 12months after the operation. For groups I and II, the mean bone graft volume loss was 46.3% and 34.6%, respectively, and the mean increase in bone density was 16% and 49%, respectively, after 12months of healing. Maxillary expansion after late SABG may be taken into consideration as a treatment choice in selected unilateral CLP patients to provide bone graft stimulation.

Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial

Autogenous bone graft harvesting is still commonly considered the gold standard for the reconstruction of a severely resorbed maxillary alveolar ridge; however, the preferred donor site remains a subject of debate. This study compared the morbidity of calvarial and iliac crest donor sites after harvesting. Twenty edentulous patients with an insufficient volume of maxillary bone for reliable implant placement were assigned randomly to either calvarial (n=10) or anterior iliac crest (n=10) bone harvesting groups. All patients underwent a maxillary sinus floor elevation procedure combined with widening of the alveolar process using buccal bone blocks. Donor site morbidity was assessed before, during, and at 1year after the surgery through patient questionnaires, physical examination, and medical records. No perioperative complications occurred. The anterior iliac crest group reported minor postoperative pain after harvesting. The scars after calvaria harvesting were significantly longer (P=0.003), but this was not bothersome for the group of patients. Long-term pain was negligible and satisfaction was high in both groups. Both the calvaria and anterior iliac crest are associated with low long-term donor site morbidity and high patient satisfaction. Thus, patient-centred decision-making is appropriate when selecting the preferred harvesting method for that patient.

Basic Science and Clinical Application of Reamed Sources for Autogenous Bone Graft Harvest.

Autologous bone graft remains the only clinically available source of graft material with osteogenic, osteoinductive, and osteoconductive properties. Although iliac crest autologous bone graft has long served as the benchmark, reamed autogenous bone graft offers several advantages. Reamed autograft has a biochemical and cellular profile that is at least equivalent, and perhaps superior, to that of iliac crest autograft. In addition, larger volumes of reamed autograft can be obtained via less-invasive techniques, giving surgeons an accessible source of mesenchymal stem cells that can be reliably and repeatedly harvested. Early clinical experience involving reamed autogenous bone graft in the management of nonunion, bone defects, and arthrodesis has been encouraging and has demonstrated the necessary properties to warrant regular consideration of reamed graft for these applications.

Autogenous bone harvesting from iliac crest and symphysis for implant reconstruction

Horizontal and vertical bone resorption may be seen after tooth loss in the maxilla and mandible. The deficient edentulous ridge may interfere with the insertion of implants of adequate length placed in the correct position and with the ideal inclination. The severe alveolar bone resorption or pneumatisation of the maxillary sinus makes it difficult to perform the conventional dental implantation procedure. Functional implant-supported oral rehabilitation is increasingly being used as a restoration strategy for fully and partially edentulous patients, whenever sufficient bone volume is available. Implant-supported restoration is possible even in severely resorbed jaws using a reconstruction technique with bone augmentation that includes vascularised or nonvascularised bone grafting and tissue regeneration techniques. Standard donor sites for free autogenous bone-graft techniques are: the chin or ramus mandible, the iliac crest, the tibia and the calvaria. Advantages of intraoral mandibular sources include easy access, low morbidity, short healing periods, minimal graft resorption, and maintenance of high bone density; side effects include possible postoperative sensory disturbances and discomfort. Calvaria and iliac crest donor areas are most commonly used in cases of extensive alveolar ridge augmentation. The iliac crest generally supplies large quantities of corticocancellous bone. In this report, we present autogenous bone graft harvesting of 48 patients (40 iliac anterior crest, 8 symphysis) for facial reconstructive surgery.

Morbidity associated with anterior iliac crest harvesting for osseous reconstruction of alveolar clefts

Introduction: The anterior iliac crest is considered the best site for harvesting autogenous bone graft for reconstruction of alveolar cleft since decades. As it is with the other sites of autogenous bone graft harvesting, anterior iliac crest also results in postoperative morbidity. The purpose of this study is to assess the associated postoperative morbidity with anterior iliac crest harvesting in the treatment of individual with alveolar clefts. Patients and Methods: A total of 92 patients with alveolar clefts were treated with autogenous bone grafting harvested from the anterior iliac crest in the duration from January 2009 to December 2014. Postoperatively, on day 1, day 7, 1st month, 3rd month, and 6th month, morbidity was assessed in these patients with postoperative pain, gait disturbance, sensory disturbance, and scarring being the parameters of assessment. Results: Postoperative pain was a complaint of all the patients on day 1 which reduced to 3.26% of patients on day 7 and after 1 month revealed no patients was experiencing pain. On day 1, 69.57% of patients and 97.83% of patients complained of sensory and gait disturbances, respectively. These numbers decreased to 6.52% and 8.7%, respectively, on day 7th, further decreasing to 2.17% and 1.09%, respectively, after 1 month. None of the patients had gait and sensory disturbances after 3 months. On scar evaluation, only one patient had a hypertrophic scar at the end of 6 months postoperatively. None of the parameters were statistically significant on completion of the 1st, 3rd, and 6th month. Conclusion: Anterior iliac crest can still be continued to be considered a first option for harvesting autogenous bone graft for rehabilitation of patients with alveolar clefts as it is well tolerated by them. It has low morbidity which allows early resumption of normal activities and has a reasonable esthetic outcome.

Donor site morbidity of anterior iliac crest and calvarium bone grafts: A comparative case-control study.

Notwithstanding its donor site morbidity, autogenous bone graft harvesting is still considered the gold standard for cases of extreme resorption of the alveolar ridge. The aim of this study was to assess donor site morbidity of calvarium and anterior iliac crest harvesting. A total of 27 edentulous patients who had undergone calvarial bone harvesting were matched with 27 edentulous patients in which anterior iliac crest bone was harvested. All patients had been treated between March 2011 and December 2013. Patients were matched according to age, sex, and duration of follow-up. Donor site morbidity was assessed by medical records, patient questionnaires, and physical examination. Patients were recalled to assess persisting morbidity of the harvesting procedure. Exposure of the dura occurred in three patients in the calvarial group. Postoperative pain (based on a visual analog scale) after harvesting was significantly higher in the anterior iliac crest group. Scars were significantly longer and contours deficits were significantly more prominent after calvarial harvesting, although not bothersome to the patients. Long-term pain was negligible in both groups, and satisfaction with the procedure did not differ. Both harvesting techniques were accompanied by low long-term donor site morbidity and high patient satisfaction.

Piezo harvesting of bone grafts from the anterior iliac crest: A technical note.

Background:Autogenous bone graft harvesting from the iliac crest is associated with donor site morbidity. The aim of this report is to describe the use of piezosurgery as an attempt at morbidity reduction.Materials and Methods:A piezosurgical handpiece and its selection of tips can easily be accommodated in an iliac crest wound to osteotomize and allow the harvest and delivery of autogenous bone grafts.Results:Corticocancellous blocks or cancellous strips of autogenous bone can be readily harvested using a piezosurgical technique at the anterior iliac crest.Conclusion:Piezosurgery avoids some of the traumatic aspects of harvesting bone associated with the use of conventional rotary instruments or saws.

Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial.

Study Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed. Autogenous iliac crest bone graft (ICBG) harvesting remains a common procedure worldwide for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern in patients undergoing spine surgery that affects postoperative functional outcome and consumes health care resources. Previous studies have noted a decrease in pain and postoperative analgesic use with the application of continuous infusion of anesthetic at the ICBG site in comparison with placebo. However, there is lack of evidence addressing the efficacy of continuous anesthetic infusion at the ICBG site in young patients and in particular those with spinal deformity, such as AIS. As such, this parallel, double-blinded, randomized controlled trial addressed the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in patients with AIS during the immediate postoperative period. Methods Participants were randomized into two groups. Group A (control subjects) received 3 mL per hour of saline locally at the ICBG site, and group B (treatment subjects) received a constant rate of infusion of 3 mL per hour of 0.25% levobupivacaine. Both groups received their postoperative intervention for 47 hours. All subjects and outcome assessors were blinded to the type of intervention. Utilizing the visual analog pain scale, pain was assessed at the primary spine surgical site, ICBG site, and contralateral ICBG site. Overall physical pain was assessed by the McGill Pain Questionnaire. The degree of analgesic use and complications were also evaluated. All outcomes were assessed up until the fourth day of the patients' hospitalization following surgery. Results Twelve subjects were recruited (five in group A; seven in group B). No difference was noted at baseline regarding age, weight, height, arm span, sex, curve type, instrumented and fused levels, length of hospitalization, and pain scores between groups. Postoperatively, no difference was noted in surgical site pain between groups (p > 0.05). However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A. Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8). No significant differences were noted for the pain scores due to the small sample size. Conclusions This study is the first with a robust level I study design to assess the efficacy of continuous infusion of analgesia into the ICBG site in young patients with AIS. This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters. This study provides further support of postoperative pain management options for children with spinal deformities.

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

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.

Donor site morbidity with reamer-irrigator-aspirator (RIA) use for autogenous bone graft harvesting in a single centre 204 case series

Donor site morbidity and complication rate using the reamer-irrigator-aspirator (RIA) system for intramedullary, non-structural autogenous bone graft harvesting were investigated in a retrospective chart and radiographic review at a University affiliated Level-1 Trauma Centre. 204 RIA procedures in 184 patients were performed between 1/1/2007 and 12/31/2010. RIA-indication was bone graft harvesting in 201 (98.5%), and intramedullary irrigation and debridement in 3 (1.5%) cases. Donor sites were: femur – antegrade 175, retrograde 4, tibia – antegrade 7, retrograde 18. Sixteen patients had undergone two RIA procedures, two had undergone three procedures, all using different donor sites. In 4 cases, same bone harvesting was done twice. Mean volume of bone graft harvested was 47±22ml (20–85ml). The complication rate was 1.96% (N=4). Operative revisions included 2 retrograde femoral nails for supracondylar femur fractures 6 and 41 days postoperatively (antegrade femoral RIA), 1 trochanteric entry femoral nail (subtrochanteric fracture) 17 days postoperatively (retrograde femoral RIA) and 1 prophylactic stabilization with a trochanteric entry femoral nail for intraoperative posterior femoral cortex penetration without fracture. In our centre, the RIA technique has a low donor site morbidity and has been successfully implemented for harvesting large volumes of nonstructural autogenous bone graft.

Outcomes Following Posterior Fusion for Adolescent Idiopathic Scoliosis With and Without Autogenous Iliac Crest Bone Graft Harvesting

Study DesignRetrospective. Summary of Background DataThere is continued controversy regarding the morbidity associated with harvesting iliac crest bone graft (ICBG). More important, its effect on clinical outcomes is poorly understood. ObjectivesThe purpose of this study was to determine whether harvesting ICBG affects clinical outcomes after posterior instrumented fusion in patients with adolescent idiopathic scoliosis (AIS). MethodsWe identified patients enrolled in a prospective, multicenter database of patients with AIS who had posterior instrumented fusion with complete preoperative and 2-year postoperative Scoliosis Research Society (SRS)-22R data. Patients who had a previous fusion, thoracoplasty, or anterior surgery were excluded. We classified patients into 2 groups: those who underwent ICBG harvest (ICBG group) and those who did not (non-ICBG group). ResultsWe included 342 patients in the ICBG group versus 563 in the non-ICBG group. There were no significant differences in preoperative age (14.9 vs. 14.8; p = .178), major Cobb angle (51.3 vs. 51.8; p = .782), minor Cobb angle (34.8 vs. 35.1; p = .846), or Pain (4.11 vs. 4.11; p = .912), Appearance (3.29 vs. 3.33; p = .384), Activity (4.15 vs. 4.14; p = .847); Mental (3.95 vs. 4.00; p = .313), or Total (3.86 vs. 3.87; p = .603) SRS-22R scores. The average operative time was slightly longer in the ICBG group (293.55 vs. 276.21 minutes; p = .002). Estimated blood loss was greater in the ICBG group (939.47 vs. 723.63 mL; p = .000; 12.2% vs. 9.2% estimated blood volume; p = .000). The average number of levels fused was similar between groups (10.6 vs. 10.3; p = .137). There were no significant differences in any of the postoperative SRS-22R domains: Pain (4.30 vs. 4.34; p = .373), Appearance (4.23 vs. 4.19; p = .310), Activity (4.31 vs. 4.33; p = .509), Mental (4.20 vs. 4.23; p = .532), Satisfaction (4.42 vs. 4.43; p = .870), or Total Score (4.27 vs. 4.29; p = .674). By 2-year follow-up, there was 1 nonunion reported in the ICBG group and none in the non-ICBG group. ConclusionsAfter posterior instrumented fusion surgery for AIS, ICBG harvesting was associated with longer operative times and increased blood loss, but did not influence 2-year outcomes, which included pain and appearance scores.