Rinsing-Suction Reamer Attenuates Intramedullary Pressure Increase and Fat Intravasation in a Sheep Model

Joist, A.; Schult, Marc; Ortmann, C.; Frerichmann, U.; Frebel, T.; Spiegel, Hans‐Ullrich; Kröpfl, A.; Redl, Heinz

doi:10.1097/01.ta.0000100379.54339.0e

Cited by 35 publications

(24 citation statements)

References 21 publications

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“…The effect of the RIA on IM pressures was assessed in three studies [12][13][14] with a further two studies assessing a similar device, the 'rinsing-suction-reamer' (RSR) [15,16]. The RSR is cannulated and flexible allowing continuous suction and irrigation during reaming similar to the RIA; however, it has only been reportedly used in the experimental setting.…”

Section: Prevention Of Fat Embolism and Thermal Necrosismentioning

confidence: 99%

“…The RSR is cannulated and flexible allowing continuous suction and irrigation during reaming similar to the RIA; however, it has only been reportedly used in the experimental setting. Three studies used animal models-one sheep [15] and two porcine [13,16]-with the others using human cadaver specimens [12,14]. A significant reduction in IM pressures, when the RIA/RSR was used as opposed to conventional reaming, was observed in four of five studies with an unexpected rise in distal pressures seen by Higgins et al (32.7±39.4 kPa in the RIA group compared with 17.0± 32.6 kPa in the standard reaming group; P=0.019) [12].…”

Section: Prevention Of Fat Embolism and Thermal Necrosismentioning

confidence: 99%

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

Cox

Jones

McGonagle

et al. 2011

International Orthopaedics (SICOT)

126

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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.

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Section: Prevention Of Fat Embolism and Thermal Necrosismentioning

confidence: 99%

Section: Prevention Of Fat Embolism and Thermal Necrosismentioning

confidence: 99%

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

Cox

Jones

McGonagle

et al. 2011

International Orthopaedics (SICOT)

126

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“…In previous in vitro investigations and animal tests, we showed that the intramedullary pressure increase and the intravasation of bone marrow content were significantly decreased. 1,2 The aim of the present study was to demonstrate whether the utilization of pressure-reduced reaming of the medullary cavity was able to reduce the systemic burden for the organism, particularly for the lung, when compared with conventional medullary reaming. This might allow expansion of the indication for reamed medullary nailing of the femur to include ''damage control orthopaedic surgery'' 3 for patients with multiple injuries.…”

Section: Introductionmentioning

confidence: 99%

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Schult

Küchle²,

Hofmann³

et al. 2006

Journal Orthopaedic Research

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Although reamed intramedullary nailing has been one of the greatest advances in modern fracture care, the concomitant increase in medullary cavity pressure leads to intravasation of bone marrow content into the blood stream, an effect that can evoke serious systemic reactions. A newly developed rinsing-suction-reamer (RSR) was able to substantially reduce the pressure and bone marrow intravasation content during experimental femoral nailing. We investigated the pathophysiological effects using the RSR, testing the hypothesis that by reducing marrow fat embolization, RSR would also reduce the activation of coagulation compared with the universial AOReamer (AOR) and comparable to external fixation. Twenty-two pigs were treated with either simulated external fixation or reamed femoral nailing using AOR or RSR. During surgery, the intramedullary pressure was measured and intravasation of medullary material was quantified. After surgery, the pigs were kept anaesthetised and monitored for 6 h. At defined intervals, serological, hematological, and hemodynamic parameters were evaluated. The RSR was significantly superior when compared to AOR with regard to the generation of intramedullary pressure and fat embolization; however, with external fixation the values were even lower. The evaluation of other parameters revealed no clear differences between the two reamers and the external fixator. The pig model showed that RSR led to a significant reduction of the intramedullary increase in pressure and fat intravasation compared to AOR. Although the reduction of fat embolism by RSR is not associated with pathophysiological changes, RSR can have advantages for the treatment of femoral fractures.

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“…Husebye et al [9] reported a lower maximum intramedullary pressure reaming with the RIA (33 ± 8 mm Hg) versus using a traditional reamer (188 ± 38 mm Hg) while reaming pig femurs. Joist et al [10] used a rinsing-suction reamer for reamed intramedullary nailing in which physiologic pressure (40 mm Hg) was exceeded only during insertion of the guide wire. This rinsing-suction reamer achieved considerably lower levels of intravenous fat, as measured by Gurd criteria, compared with a standard AO reamer.…”

Section: Discussionmentioning

confidence: 99%

“…The number of fat particles observed in the lungs postoperatively correlates with increased femoral intramedullary pressure when a TKA is performed using conventional instrumentation (eg, drill, intramedullary alignment guide, and so on) [10,16]. Although the exact femoral intramedullary pressure threshold that leads to fat embolism has not been studied in humans [13], a sheep model suggests emboli (bone marrow surrounded by a thrombotic aggregate) appear at intramedullary pressures greater than 200 mm Hg [21].…”

Section: Introductionmentioning

confidence: 99%

The Reamer/Irrigator/Aspirator Reduces Femoral Canal Pressure in Simulated TKA

Gorp

Falk

Kmiec

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Inserting the femoral intramedullary alignment rod during total knee arthroplasty (TKA) can generate high intramedullary pressure, which increases the risk of intraoperative complications caused by fat embolism. Despite modifications to the surgical procedure, the best method to prevent this increase in pressure remains unknown. The reamer/irrigator/aspirator is a surgical instrument designed for use during femoral canal entry to increase the canal size and remove intramedullary fat and may prevent this pressure increase. We posed two hypotheses: (1) using the reamer/ irrigator/aspirator system will result in lower maximum femoral intramedullary pressure than using only conventional instrumentation during the initial steps of a TKA; and (2) using the reamer/irrigator/aspirator system in the initial steps of TKA will result in a mean maximum intramedullary pressure less than 200 mm Hg. We simulated a TKA on 14 cadaveric femurs to compare the femoral intramedullary pressure using both methods. Considerable decreases in femoral intramedullary pressure of 86% proximally and 87% distally were obtained by using the reamer/irrigator/aspirator system. The mean maximum pressure using the reamer/irrigator/aspirator system was less than 200 mm Hg. Additional clinical studies are needed to confirm any reduction in complications using the reamer/irrigator/aspirator system.

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Rinsing-Suction Reamer Attenuates Intramedullary Pressure Increase and Fat Intravasation in a Sheep Model

Abstract: Because we found only a minimal increase of the pulmonary arterial pressure as a sign of pulmonary embolism, we conclude that by using the RSR, the systemic side effects caused by intravasation of medullary content during reaming could be reduced as far as possible.

Cited by 35 publications

References 21 publications

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

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

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

The Reamer/Irrigator/Aspirator Reduces Femoral Canal Pressure in Simulated TKA

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