Hemorrhagic-Induced Cardiovascular Complications During Reamer–Irrigator–Aspirator-Assisted Femoral Nonunion Treatment

Donders, Johanna C. E.; Baumann, Holger; Stevens, Markus F.; Kloen, Peter

doi:10.1097/bot.0000000000000612

Cited by 8 publications

(9 citation statements)

References 20 publications

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“…Thirteen studies [ 18 , 42 , 43 , 45 , 47 , 48 , 50 , 55 – 60 ] reported blood loss in a total number of 336 performed procedures with the RIA system. Of these 13 studies, five studies [ 47 , 48 , 50 , 56 , 58 ] reported the volume of blood lost, which resulted in a mean of 803.29 ml per case.…”

Section: Resultsmentioning

confidence: 99%

“…However, application of the RIA system can also cause serious complications. The RIA system is considered an one-time aggressive reamer with continuous irrigation at the reamer head that can cause eccentric reaming and blood loss, causing iatrogenic fractures and cardiopulmonary disturbances, respectively [ 17 , 18 ]. However, precisely these features of powerful evacuation on medullary canal content furthered the application of the RIA device as a multipurpose tool to lower the risk of dissemination into the soft tissues and systemic circulation as well as clearing the femoral/tibial canal of cement debris.…”

Section: Introductionmentioning

confidence: 99%

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Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Laubach

Weimer

Bläsius

et al. 2022

Arch Orthop Trauma Surg

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Introduction Complications associated with the application of the Reamer–irrigator–Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted. Materials and methods The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system. Results Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2–3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00–6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80–26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69–4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed. Conclusions The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Laubach

Weimer

Bläsius

et al. 2022

Arch Orthop Trauma Surg

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“…These case reports found that each cardiac event happened toward the end of the RIA procedure, possibly resulting from underestimated blood loss with high volumes of irrigation fluid used. 18 Dawson et al found that operative time and amount of graft harvested differed significantly between RIA and ICBG. On average, the patients undergoing graft harvest with RIA had less operative time, less pain, and greater volume of graft harvested, 12 but healing rate and time to healing did not vary significantly.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reamer Irrigator Aspirator Versus Iliac Crest Bone Grafting and Proximal Tibial Curettage: Is There a Difference in Blood Loss and Transfusion Rates?

Martella

Schumaier

Sirignano

et al. 2022

Journal of Orthopaedic Trauma

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“…Although RIA has achieved very promising results with respect to cavity defects, this technique is less useful for segmental ones, for which osteosynthesis supplementation is required. Furthermore, complications can arise in relation to the learning curve, to over-reaming and, in some patients, to cardiac problems produced by rapid blood loss; the latter complication is closely related to previous cardiopathy[ 22 , 23 ].…”

Section: Reamer-irrigator-aspiratormentioning

confidence: 99%

Challenges of bone tissue engineering in orthopaedic patients

Guerado

Caso

2017

WJO

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Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked - with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator (RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine (or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.

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Hemorrhagic-Induced Cardiovascular Complications During Reamer–Irrigator–Aspirator-Assisted Femoral Nonunion Treatment

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 8 publications

References 20 publications

Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Reamer Irrigator Aspirator Versus Iliac Crest Bone Grafting and Proximal Tibial Curettage: Is There a Difference in Blood Loss and Transfusion Rates?

Challenges of bone tissue engineering in orthopaedic patients

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