A radiographic and clinical comparison of reamer–irrigator–aspirator versus iliac crest bone graft in ankle arthrodesis

Nodzo, Scott R.; Kaplan, Nathan; Hohman, Donald W.; Ritter, Christopher

doi:10.1007/s00264-014-2348-4

Cited by 24 publications

(12 citation statements)

References 26 publications

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“…One of the few available studies reported that 7.4% (2 of 27 patients) of patients reported clinically significant, chronic pain at their iliac crest graft harvest site at the 3-year follow-up. 6 Similarly, the precursor study to this report found that nearly 10% of subjects had clinically significant graft site pain at 52-week follow-up. 2 The proximal tibia was associated with a higher number of subjects with clinically significant pain than the iliac crest.…”

Section: Discussionmentioning

confidence: 59%

Long-term Autograft Harvest Site Pain After Ankle and Hindfoot Arthrodesis

et al. 2020

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Background: Pain following autograft harvest has been studied; however, published literature has typically focused on the iliac crest with follow-up limited to only a few years. It remains unknown if pain continues or improves over time. The purpose of this study was to evaluate long-term pain associated with autograft harvest to supplement hindfoot or ankle arthrodesis. Methods: Subjects in the control arm of a previously conducted trial comparing autograft with a synthetic bone graft for hindfoot or ankle arthrodesis were invited back for a single visit at a minimum of 5 years following their initial surgery. Harvest site, fusion site, and weight-bearing pain were evaluated using a 100-point visual analog scale (VAS). Of the 130 invited subjects, 60 (46.1%) returned for assessment, 58 of whom completed pain assessments. Results: At a mean follow-up of 9.0 years (range, 7.8-10.5), more than a third (36.6%) of subjects had some level of harvest site pain. Using VAS greater than 20 mm as a threshold of clinical significance, pain remained clinically significant in 5.2% of subjects. There was a significant correlation between harvest site pain and both weight-bearing and fusion site pain. There was not a significant correlation between harvest site pain and volume of graft harvested. Conclusion: Autograft harvest can result in chronic, clinically significant pain that can last up to 10 years. In the era of shared decision making, this information will help surgeons and patients quantify the risks of chronic pain after arthrodesis procedures that include a secondary operative incision for graft harvest. Level of Evidence: Level II, prospective comparative study.

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Section: Discussionmentioning

confidence: 59%

Long-term Autograft Harvest Site Pain After Ankle and Hindfoot Arthrodesis

et al. 2020

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“…Furthermore, On Salawu et al reported a higher union rate following ICBG, with 81 unions in 86 patients [ 36 ]. In this regard, the data in the literature are controversial, because the RIA group is characterized by a higher union rate [ 17 , 25 ]. Han et al reported 50 unions in 57 patients after the RIA procedure [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes and complications of the reamer irrigator aspirator versus traditional iliac crest bone graft harvesting: a systematic review and meta-analysis

et al. 2021

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Background The reamer irrigator aspirator (RIA) is a relatively recent device that is placed in the medullary canal of long bones to harvest a large volume of bone marrow, which is collected in a filtered canister. This study compares outcomes and complications of the RIA versus a traditional iliac crest bone graft (ICBG) for the treatment of bone defects. Methods This meta-analysis was conducted according to the PRISMA guidelines. The Embase, Google Scholar, PubMed, and Scopus databases were accessed in June 2021. All clinical trials comparing the RIA and ICBG with a minimum of 6 months follow-up were included. Results Data from 4819 patients were collected. The RIA group demonstrated lower site pain (P < 0.0001), fewer infections (P = 0.001), and a lower rate of adverse events (P < 0.0001). The ICBG group demonstrated a greater rate of bone union (P < 0.0001). There was no difference between groups in VAS (P = 0.09) and mean time to union (P = 0.06). Conclusion The current evidence supports the use of the RIA, given its low morbidity and short learning curve.

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“…In clinical fusion procedures, femoral ring and femoral dowel allografts have been widely employed as osteoconductive structural grafts in interbody procedures [29][30][31][32][33], while femoral head allograft has been successfully used in interbody [16,[34][35][36], and posterolateral lumbar procedures [15,17]. With increasing interest in the use of femoral reamer-irrigator-aspirator (RIA) bone autograft, a number of clinical studies have recently compared the efficacy of RIA and iliac crest autograft in nonunion, posttraumatic segmental bone defect, or ankle fusion patients and have observed comparable [37][38][39][40], or increased union rates and times to union [41]. Femoral RIA autograft has also been successfully used in clinical interbody and posterolateral fusion procedures [42,43].…”

Section: Discussionmentioning

confidence: 99%

Comparing the efficacy of syngeneic iliac and femoral allografts with iliac crest autograft in a rat model of lumbar spinal fusion

et al. 2020

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Background Despite widespread use of femoral-sourced allografts in clinical spinal fusion procedures and the increasing interest in using femoral reamer–irrigator–aspirator (RIA) autograft in clinical bone grafting, few studies have examined the efficacy of femoral grafts compared to iliac crest grafts in spinal fusion. The objective of this study was to directly compare the use of autologous iliac crest with syngeneic femoral and iliac allograft bone in the rat model of lumbar spinal fusion. Methods Single-level bilateral posterolateral intertransverse process lumbar spinal fusion surgery was performed on Lewis rats divided into three experimental groups: iliac crest autograft, syngeneic iliac crest allograft, and syngeneic femoral allograft bone. Eight weeks postoperatively, fusion was evaluated via microCT analysis, manual palpation, and histology. In vitro analysis of the colony-forming and osteogenic capacity of bone marrow cells derived from rat femurs and hips was also performed to determine whether there was a correlation with the fusion efficacy of these graft sources. Results Although no differences were observed between groups in CT fusion mass volumes, iliac allografts displayed an increased number of radiographically fused fusion masses and a higher rate of bilateral fusion via manual palpation. Histologically, hip-derived grafts showed better integration with host bone than femur derived ones, likely associated with the higher concentration of osteogenic progenitor cells observed in hip-derived bone marrow. Conclusions This study demonstrates the feasibility of using syngeneic allograft bone in place of autograft bone within inbred rat fusion models and highlights the need for further study of femoral-derived grafts in fusion.

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A radiographic and clinical comparison of reamer–irrigator–aspirator versus iliac crest bone graft in ankle arthrodesis

Abstract: There was a significantly higher nonunion rate in the ICBG group, but both groups had a solid radiographic bony fusion at similar follow-up time points. Our results suggest RIA bone graft is a viable alternative to ICBG for tibiotalar fusion.

Cited by 24 publications

References 26 publications

Long-term Autograft Harvest Site Pain After Ankle and Hindfoot Arthrodesis

Long-term Autograft Harvest Site Pain After Ankle and Hindfoot Arthrodesis

Outcomes and complications of the reamer irrigator aspirator versus traditional iliac crest bone graft harvesting: a systematic review and meta-analysis

Comparing the efficacy of syngeneic iliac and femoral allografts with iliac crest autograft in a rat model of lumbar spinal fusion

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