Bone Graft Harvest Using a New Intramedullary System

Abstract

Obtaining autogenous bone graft from the iliac crest can entail substantial morbidity. Alternatively, bone graft can be harvested from long bones using an intramedullary (IM) harvesting system. We measured bone graft volume obtained from the IM canals of the femur and tibia and documented the complications of the harvesting technique. Donor site pain and the union rate were compared between the IM and the traditional iliac crest bone graft (ICBG) harvest. Forty-one patients (23 male, 18 female) with an average age of 44.9 years (range, 15-78 years) had graft harvested from long bones using an IM harvest system (femoral donor site, 37 patients; tibial donor site, four patients). Forty patients (23 male, 17 female; average age, 46.4 years; range, 15-77 years) underwent anterior ICBG harvest. We administered patient surveys to both groups to determine pain intensity and frequency. IM group reported lower pain scores than the ICBG group during all postoperative periods. Mean graft volume for the IM harvest group was 40.3 mL (range, 25-75 mL) (graft volume was not obtained for the ICBG group). Using an intramedullary system to harvest autogenous bone graft from the long bones is safe provided a meticulous technique is used.

Reamer-irrigator-aspirator indications and clinical results: a systematic review

“…The RIA has been reported as a source of bone graft with supportive experimental [17] and clinical studies [5,[7][8][9] and case reports [6,[20][21][22][23]. Direct grafting of harvested RIA bone fragments, in addition to 'autografting' alone has been shown to improve stiffness (1.21 Nm compared with 0.48 Nm; P=0.029) and strength (14.09 Nm compared with 6.94 Nm; P=0.029) in a sheep model [19].…”

“…Direct grafting of harvested RIA bone fragments, in addition to 'autografting' alone has been shown to improve stiffness (1.21 Nm compared with 0.48 Nm; P=0.029) and strength (14.09 Nm compared with 6.94 Nm; P=0.029) in a sheep model [19]. Large volumes of graft can be obtained, with 40-90 ml harvests being reported [5,[7][8][9]. This graft has been shown to be 'comparable to iliac crest' in terms of osteoinductive growth factors [24], and high union rates have been reported in clinical series (50-90%) [5,[7][8][9].…”

“…Large volumes of graft can be obtained, with 40-90 ml harvests being reported [5,[7][8][9]. This graft has been shown to be 'comparable to iliac crest' in terms of osteoinductive growth factors [24], and high union rates have been reported in clinical series (50-90%) [5,[7][8][9]. It is noted that union rates reported by Belthur et al using RIA derived graft (37 of 41 cases) compared well with an iliac crest bone graft (ICBG) control group (32 of 40 cases) [7].…”

“…When combining all 87 patients from initial studies [5,[7][8][9], only three complications are reported: (1) femoral neck fracture, (2) perforation of the anterior cortex of the femur, and (3) hypertrophic scar. All complications were successfully managed, with the femoral neck fracture being fixed and the other two managed non-operatively [5,7].…”

“…Reported indications for the RIA have expanded since its inception to include treating postoperative osteomyelitis [4], using the aspirated bone-fragments as bone graft to treat non-unions [5][6][7][8][9][10] and harvesting mesenchymal-stemcells (MSCs) [11]. A systematic review of this device is necessary to inform the wider orthopaedic community of the RIAs indications, efficacy and safety.…”