Utilizing reamer irrigator aspirator (RIA) autograft for opening wedge high tibial osteotomy: A new surgical technique and report of three cases

Abstract

INTRODUCTIONThe lateral closing wedge high tibial osteotomy (HTO) was popularized by Coventry in the 1960s. In the 1990s the medial opening wedge osteotomy gained popularity because it could achieve greater valgus correction and it did not require dissociation of the fibula from the tibia, an important consideration when treating varus knees with lateral and posterolateral ligament deficiencies (Noyes’ double-varus and triple-varus knees). However, it has the disadvantage of requiring bone graft to fill bony defects. Recently, the reamer-irrigator-aspirator (RIA; Synthes, Paoli, PA) system was developed, and as a result of this procedure, a large amount of usable autogenous bone graft can be collected safely for use. To our knowledge, there is no published series combining opening wedge HTO with the use of RIA obtained autogenous bone graft.PRESENTATION OF CASEWe present a novel technique in which a series of three patients underwent opening wedge HTO using ipsilateral, retrograde femur RIA graft to fill the bone defect. All patients had satisfactory clinical and radiologic outcomes following the new technique at latest follow up.DISCUSSIONOpening wedge high tibial osteotomy is a well-documented and accepted orthopedic procedure, however, has the disadvantage of requiring varying amounts of bone graft. Traditionally, iliac crest or tricortical allograft have been the grafting modalities of choice, however both have inherent drawbacks to their use. In our series, the use of RIA autograft is a safe and reliable harvest technique for high tibial osteotomy, providing abundant and quality autogenous bone graft.CONCLUSIONAll three of our patients achieved radiographic union with high clinical patient satisfaction without any major complications. We feel this novel technique is a safe and acceptable operative solution grafting opening wedge osteotomies about the knee.

Corrective Osteotomies in Severe Non-Idiopathic Lower Limb Alignment Disorders in the Aspect of Future Joint Endoprosthesis—A Perspective Study

“…Novel studies are aiming to investigate the best material for bone graft. Using the reamer-irrigator-aspirator system and collecting the ipsilateral bone graft from the femur may be a promising option in such cases [28].…”

The challenges of a comprehensive surgical approach to Blount's disease

“…The potential complications of bone grafting include infection, pain and failure. 26 , 27 As patients requiring high degrees of correction often yield less than adequate bone, 28 this method is not advocated.…”