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

Martella, Anthony; Schumaier, Adam P.; Sirignano, Michael N; Sagi, H. Claude; Wyrick, John D.; Archdeacon, Michael T.

doi:10.1097/bot.0000000000002256

Cited by 7 publications

(7 citation statements)

References 17 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. Furthermore, five out of the 13 studies reported a drop in hemoglobin, resulting in a mean of 3.74 g/dl.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, five out of the 13 studies reported a drop in hemoglobin, resulting in a mean of 3.74 g/dl. In total, 60 out of 583 patients (9.72%) included in the studies [ 18 , 42 , 43 , 45 , 47 , 48 , 57 , 59 , 60 ] required blood transfusion. The findings on blood loss are summarized in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Clinically significant blood loss during RIA system application, which is associated with continuous irrigation due to the abundant intramedullary blood supply, was first reported in smaller case series [ 18 , 58 ] and more recently confirmed in multiple larger studies [ 43 , 47 , 50 , 71 ]. In the present systematic literature review, a mean blood loss of 803.29 ml, a drop in hemoglobin of 3.74 mg/dl and required blood transfusion in 9.72% of patients were observed.…”

Section: Discussionmentioning

confidence: 99%

“…In the present systematic literature review, a mean blood loss of 803.29 ml, a drop in hemoglobin of 3.74 mg/dl and required blood transfusion in 9.72% of patients were observed. It should be noted that blood loss, particularly in surgically complex patients, is multifactorial and might be affected by perioperative and postoperative fluid administration regimes; the complexity of the nonunion repair, including the extent of recipient site preparation; and the amount of ABG required [ 71 ]. Nonetheless, these findings are paramount for every surgeon, as surgical planning includes interdisciplinary communication and preparation for potential intraoperative blood loss.…”

Section: Discussionmentioning

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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…In case of an atrophic or hypotrophic pseudarthrosis, vitalizing of the bony edges and implantation of a cancellous bone graft, e.g., of the iliac crest, the proximal tibia or from the calcaneus, is generally considered as gold standard. Alternatively, autologous intramedullary bone grafts can also be harvested from the femoral shaft using the Reamer-irrigator aspirator device (RIA) [ 3 , 4 , 5 ]. However, supply is often limited, and these treatment options have demonstrated varied success rates.…”

Section: Introductionmentioning

confidence: 99%

Enhanced BMP-2-Mediated Bone Repair Using an Anisotropic Silk Fibroin Scaffold Coated with Bone-like Apatite

Deininger

Wagner

Heimel

et al. 2021

IJMS

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The repair of large bone defects remains challenging and often requires graft material due to limited availability of autologous bone. In clinical settings, collagen sponges loaded with excessive amounts of bone morphogenetic protein 2 (rhBMP-2) are occasionally used for the treatment of bone non-unions, increasing the risk of adverse events. Therefore, strategies to reduce rhBMP-2 dosage are desirable. Silk scaffolds show great promise due to their favorable biocompatibility and their utility for various biofabrication methods. For this study, we generated silk scaffolds with axially aligned pores, which were subsequently treated with 10× simulated body fluid (SBF) to generate an apatitic calcium phosphate coating. Using a rat femoral critical sized defect model (CSD) we evaluated if the resulting scaffold allows the reduction of BMP-2 dosage to promote efficient bone repair by providing appropriate guidance cues. Highly porous, anisotropic silk scaffolds were produced, demonstrating good cytocompatibility in vitro and treatment with 10× SBF resulted in efficient surface coating. In vivo, the coated silk scaffolds loaded with a low dose of rhBMP-2 demonstrated significantly improved bone regeneration when compared to the unmineralized scaffold. Overall, our findings show that this simple and cost-efficient technique yields scaffolds that enhance rhBMP-2 mediated bone healing.

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Proximal Tibia Plating Failed Fixation

Vallier

2024

Failed Fracture Fixation

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

Abstract: Objectives: To compare blood loss and transfusion rates among reamer irrigator aspirator (RIA), iliac crest bone graft (ICBG), and proximal tibial curettage (PTC) for autograft harvest.

Cited by 7 publications

References 17 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

Enhanced BMP-2-Mediated Bone Repair Using an Anisotropic Silk Fibroin Scaffold Coated with Bone-like Apatite

Proximal Tibia Plating Failed Fixation

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