Complications Associated With Negative Pressure Reaming for Harvesting Autologous Bone Graft: A Case Series

Abstract

A technical benefit of the reamer-irrigator-aspirator (RIA) system (Synthes, Paoli, PA) is the ability to harvest large volumes (40-90 cm3) of autogenous bone graft. Early evaluations of this technique have reported few problems, all of which were attributed to technical error. This case series reviews 6 RIA-associated complications including 4 fractures and their contributing risk factors. Cases were collected from 4 independent orthopaedic centers, and all patients underwent RIA bone graft harvesting in a lower extremity long bone injuries. In this population, 2 patients experienced acute RIA-associated events, necessitating an additional procedure or altered postoperative rehabilitation, whereas 4 patients fractured through their donor site in the early postoperative period. This series suggests that surgeons should (1) preoperatively assess cortical diameters at long bone harvest sites, (2) carefully monitor intraoperative reaming, and (3) avoid RIA bone graft harvesting in patients with a history of osteoporosis or osteopenia unless postharvest intramedullary stabilization is considered.

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

“…The case series of complications reported by Lowe et al is a concern; however, it is unclear as to the incidence of these events from this report [25]. The other evidence suggests that the RIA is relatively safe, with a relatively low rate of complications (three of 87 cases) [5,[7][8][9].…”

“…A more recent case series (six patients) of RIA related complications reported three diaphyseal fractures, one trochanteric fracture and two cortical breeches. These were all successfully treated with intra-medullary nail (four of six cases) and cephallomedullary nail (one of six cases) fixation, and in one case the cortical breech was deemed sufficiently small to manage non-operatively [25]. Belthur et al found a reduction in postoperative pain when compared with conventional iliac crest bone graft (ICBG) harvest and overall the RIA appears well tolerated [5].…”

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].…”