Use of the reamer–irrigator–aspirator technique to obtain autograft for ankle and hindfoot arthrodesis

Abstract

The use of autograft bone is the best option when undertaking a procedure that requires bone graft because it is osteogenic, osteoconductive and osseo-inductive. Pain, morbidity and complications associated with harvesting iliac or non-iliac sites occur in between 6% and 30% of cases. An alternative source of graft with possibly a lower morbidity is the intramedullary canal. In this study, 28 patients undergoing 30 arthrodesis procedures on the hindfoot had a mean of 48 cm(3) (43 to 50) of bone harvested locally from the hindfoot or the tibial shaft by antegrade or retrograde reaming. No patient sustained a fracture of the calcaneum, talus or tibia. There was no morbidity except for one complication when the reamer breached the medial tibial cortex. This healed uneventfully. This method of using the reamer-irrigator-aspirator system is an extension of the standard technique of intramedullary reaming of the lower limb: it produces good-quality bone graft with viable growth factors consistent with that of the iliac crest, and donor site morbidity is low. This is an efficient method of obtaining autologous bone for use in arthrodesis of the ankle or hindfoot.

Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients

“…Autologous bone grafting has received a negative reputation in the past, mainly due to the high risk of postoperative complications related to the harvesting procedure [6]. However, more recent innovative and minimally invasive harvesting techniques have mitigated the historic issue of donor site morbidity and renewed the interest in autologous bone as a preferred source for bone grafting [7-9]. …”

The viability of cells obtained using the Reamer–Irrigator–Aspirator system and in bone graft from the iliac crest

“…The effluent collected using RIA also contains many osteogenic growth factors, 4,15,16 and the filter system can provide large volumes of bone graft. 17 Although RIA has been used clinically, 18 there is no evidence to suggest that these cells remain viable. Therefore the questions raised are, is the apparent clinical success related to the growth factors or due to the osteogenic cells?…”

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

“…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.…”