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

Abstract

Background The 'reamer-irrigator-aspirator' (RIA) is an innovation developed to reduce fat embolism (FE) and thermal necrosis (TN) that can occur during reaming/ nailing of long-bone fractures. Since its inception its indications have expanded to include the treatment of long-bone osteomyelitis and as a harvester of bone graft/ mesenchymal stem cells (MSCs). Methods This study involved a systematic review, via Pubmed® and Google Scholar®, of English language sources (nine non-clinical studies, seven clinical studies and seven case reports) using the keywords: 'reamer', 'irrigator', 'aspirator' (1st May 2010). Sources were reviewed with reference to the RIAs efficacy in (1) preventing FE/TN, (2) treating long-bone osteomyelitis, (3) harvesting bone graft/MSCs, and (4) operating safely. Experimental data supports the use of the RIA in preventing FE and TN, however, there is a paucity of clinical data. Conclusions The RIA is a reliable method in achieving high volumes of bone graft/MSCs, and high union rates are reported when using RIA bone-fragments to treat nonunions. Evidence suggests possible effectiveness in treating long-bone osteomyelitis. The RIA appears relatively safe, with a low rate of morbidity provided a meticulous technique is used. When complications occur they respond well to conventional techniques. The RIA demands further investigation especially with respect to the optimal application of MSCs for bone repair strategies.

Bone Regeneration Based on Tissue Engineering Conceptions — A 21st Century Perspective

“…The innovation driven by the RIA systems was so significant, that the Journal "Injury" has dedicated a complete issue to the data available on RIA and its applications recently (71). A systematic review on the Reamer-irrigator-aspirator indications and clinical results has recently been published by Cox et al (72). The Masquelet technique as well as the RIA-system is nowadays frequently used in clinical practice, independently.…”

Advanced concepts in knee arthrodesis

“…The RIA system can be used in an antegrade or retrograde fashion, and the technique is described in multiple papers [15][16][17][18][19] . After the bone graft harvest site is closed and sterile dressings have been applied, the graft is placed in a sterile cup on the back table.…”

Massive Blood Loss during Graft Harvesting with the Reamer Irrigator-Aspirator

“…Although it is advantageous compared to standard iliac crest graft harvesting in terms of graft volume, donor side morbidity and possibly quality of graft [1,3,7], it is not without complications. Previous studies have highlighted the possibility of fractures and cortical breaching [1,2,[4][5][6]. Although the possibility of significant blood loss has also been mentioned in the majority …”

“…Its indications have expanded since then, and it is now used for intramedullary debridement for the treatment of osteomyelitis and for bone graft harvesting [1,2]. of these studies [2,[4][5][6]8], there are not many reported cases with massive blood loss. Quintero et al6reported on 20 cases; one of them developed intraoperative hypovolemia.…”

“…However, the RIA is not without complications: amongst others, the possibility of considerable blood loss has also been mentioned [1,2,[4][5][6].…”