Retrograde Versus Antegrade Femoral Bone Graft Harvesting Using the Reamer–Irrigator–Aspirator

Davis, Richard L.; Taylor, Benjamin C.; Johnson, Nathan; Ferrel, Jason R.; Castañeda, Joaquín Fernández de la Concha

doi:10.1097/bot.0000000000000300

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…Numerous studies have shown that RIA can provide good quality and quantity of autologous bone graft with relatively little post-operative pain [6][7][8] Table 1 [4,5,9,[10][11][12][13][14][15][16][17]. Most reported complications were seen when the intact femur was used as source of harvesting autologous bone graft.…”

Section: Discussionmentioning

confidence: 99%

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

Donders

Baumann²,

Stevens

et al. 2016

Journal of Orthopaedic Trauma

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Section: Discussionmentioning

confidence: 99%

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

Donders

Baumann²,

Stevens

et al. 2016

Journal of Orthopaedic Trauma

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“…Due to the possibility of generating eccentric or excessive reaming of the canal during the RIA technique, iatrogenic femoral fractures were previously reported on the literature [ 6 , 9 , 15 ]. Han et al evaluated 57 patients treated using the RIA system and reported a femoral fracture at the graft harvesting site that required fixation with an intramedullary nail [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although a previous study comparing antegrade and retrograde techniques using the RIA system have shown similar morbidity and amount of bone graft harvested, a special concern exists when using the antegrade pathway due to the risk of eccentric reaming, potentially predisposing to an iatrogenic fracture [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a novel retrograde route for femoral bone graft harvesting by Reamer-Irrigator-Aspirator: a pilot study on 24 patients

Bidolegui¹,

Pereira²,

Irigoyen³

et al. 2022

Patient Saf Surg

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Background The Reamer–Irrigator–Aspirator system was initially developed to reduce fat embolism and thermic necrosis during reamed intramedullary nail fixation of femoral shaft fractures. Currently, this system is used in extended applications including accessing large volume of autologous bone graft, as alternative for iliac crest harvesting. Antegrade femoral bone graft harvesting using the Reamer-Irrigator-Aspirator system is considered the standard technique. The aim of our study is to evaluate the efficacy (bone graft volume) and the complications (blood loss, postoperative pain, and incidence of iatrogenic fractures) of the Reamer–Irrigator–Aspirator system through the retrograde femoral route in a series of patients with post-traumatic bone defects or nonunions. Methods A non-controlled single center retrospective observational cohort study was conducted in a level1 trauma center to evaluate all patients who were treated using the RIA system. Between November 2015 and May 2019, 24 patients (8 women and 16 men; mean age: 41 years [range 27–55 years]) with bone defects or nonunions underwent bone graft harvesting using the Reamer–Irrigator–Aspirator system through retrograde femoral route. Postoperative pain, complications, and bone graft volume were analyzed. Inclusion criteria was patients older than 18 years with a diagnosis of post-traumatic bone defect or associated tibial or femoral nonunion, with minimum 6-months follow, treated using the RIA. We hypothesized that the retrograde route of the RIA system is a safe and efficacious method for bone harvesting. Results The average volume of collected graft was 45 cc (range 30–60 cc). In 83% of the cases, bone grafting was sufficient, while in 17% it was necessary to add iliac crest bone graft to completely fill the bone defect. A mean drop in postoperative hemoglobin of 4.1 g / dL (range 0.5–6.0 g / dL) was evidenced. In 4 cases (33%), a unit of packed red blood cells was required. Regarding postoperative pain, visual analogue scale after 3 months postoperatively was 1.6 in average. After 6 months, the value has decreased to 0.4. There were no perioperative or postoperative complications at 6-month follow-up. Conclusion In this limited case series, large volumes of bone graft were harvested using the retrograde route of the RIA system and there were no intra-/ postoperative complications observed at 6-month follow-up. Therefore this novel technique appears safe and efficacious. However, it’s important to highlight that future prospective controlled studies are necessary to validate the insights from this pilot study.

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“…RIA has similar outcomes among all human races[ 13 ], and can be performed either antegradely or retrogradely[ 33 , 34 ].…”

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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Retrograde Versus Antegrade Femoral Bone Graft Harvesting Using the Reamer–Irrigator–Aspirator

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

Cited by 8 publications

References 11 publications

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

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

Safety and efficacy of a novel retrograde route for femoral bone graft harvesting by Reamer-Irrigator-Aspirator: a pilot study on 24 patients

Challenges of bone tissue engineering in orthopaedic patients

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