Harvest of cortico-cancellous intramedullary femoral bone graft using the reamer-irrigator-aspirator (RIA)

Abstract

The "Reamer-Irrigator-Aspirator" (RIA) is a device that provides continuous irrigation and aspiration during intramedullary reaming of long bones. The RIA system is first used to collect the reaming material from medullary cavities, a thick paste of finely morselized osseous particles containing significantly elevated levels of stem cells and growth factors as reported by quantitative analyses. The volume of bone graft material available from an adult femur corresponds to the amount of cancellous bone graft obtained from both the anterior and posterior iliac crests. The assembly and technicalities of the RIA system require a training period to prevent any femoral fracture, which appears to be the major RIA-related complication. The elective indications for RIA bone grafting are filling of bone defects in the epiphyseal and metaphyseal regions. Diaphyseal defects may also be managed using the RIA system provided the graft is placed in a constrained system (induced membrane) to prevent dispersion of the graft into the surrounding soft tissues and is aerated with a porous material to promote its revascularization. Other RIA indications include debriding intramedullary infections and reaming for intramedullary nailing of long bone fractures to reduce the risk of fat embolization.

Case Series of Femoral Shaft Fractures Innovatively Managed by Using Reamed Material as Internal Bone Graft for Early Fracture Union

“…14,15,17,21 The intramedullary reaming debris has an abundance of progenitor cells and growth factors. [21][22][23][24] Various papers establish that the benefit from reamed particles is the existence of viable osteoprogenitors within the bone matrix itself, not merely in the marrow, which is well accepted. 15,21,24,25 Quantitative analysis of the reaming debris have found higher levels of fibroblast growth factor (FGFa), platelet-derived growth factor (PDGF), insulin like growth factor (IGF)-1, BMP-2, and transforming growth factor (TGF)-b1 which play a vital role in osteosynthesis.…”

“…The collected material is extremely dense with "moist sand" like consistency. 23 Another benefit of intramedullary canal bone graft is that it is harvested using a reamer which is an inherent procedure of fixation. Tuli et al 25 performed a study on harvesting progenitor cells from trabecular bone.…”

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

“…Three other papers mentioned blood loss during RIA, but did not go into detail [18][19][20]. Masquelet et al recommend that "aspiration should be turned off when reaming is stopped to reduce bleeding" [18], Cobbs suggests monitoring the color of the flow, as the tubing "turns red with blood" when the RIA is advanced.…”

“…Masquelet et al recommend that "aspiration should be turned off when reaming is stopped to reduce bleeding" [18], Cobbs suggests monitoring the color of the flow, as the tubing "turns red with blood" when the RIA is advanced. The RIA should then be withdrawn "until it clears, or lightens in color" [19].…”

Reconstrucción de defectos óseos segmentarios postraumáticos mediante técnica de inducción de membrana

“…Es necesario preparar durante el acto quirúrgico ambas crestas iliacas o la cresta iliaca posterior. Un sistema de fresado del canal femoral y aspiración simultanea (Reamer/Irrigator/ Aspirator -RIA) sería una alternativa para obtener volúmenes entre 30 a 90 cc de injerto (38,39). En nuestra serie se utilizó RIA en dos pacientes (caso 9 y caso 19).…”