Complications and Risk Management in the Use of the Reaming-irrigator-aspirator (RIA) System: RIA is a Safe and Reliable Method in Harvesting Autologous Bone Graft

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Apr 27

PMID 29698513

Citations 15

Authors

Patrick Haubruck

Julian Ober

Raban Heller

Matthias Miska

Gerhard Schmidmaier

Michael C Tanner

Affiliations

Soon will be listed here.

Abstract

Background: Autologous bone grafting (ABG) remains the gold standard for augmentation of bone defects. The RIA system has become more prevalent, but evidence regarding risk management and complications remain scarce. This study presents the risk management and complications associated with RIA in the largest single-center case series to date.

Methods: All records, operative notes, lab data and radiographs of patients receiving a RIA procedure at Heidelberg´s University Hospital between 01/01/2010 and 31/12/2016 were reviewed. Multivariate logistic regression models adjusting for clinically relevant covariates were used to examine the respective relevance regarding the presence and absence of prolonged postoperative pain (PPP).

Results: A total of 341 RIA procedures on 306 patients were performed at our level-1 trauma center. The femur was the main donor site (98.53%; N = 336) whereas only in 1.47% (N = 5) the tibia was utilized. A total of 11 patients showed a relevant loss of hemoglobin requiring blood transfusion. A total of 22 patients suffered from PPP directly associated with the RIA procedure resulting in prevalence of 6.45%. The 6 major complications in our study were of diverse origin and all intraoperative complications took place in the early phase of the RIA procedure in our center (2010-2013). Our data revealed influence of sex (p = 0.0459) and age (p = 0.0596) on the criterion PPP. The favored model including sex and age resulted in an AUC of 66.2% (CI: 55.5%-76.9%).

Conclusion: Perioperative blood loss remains a prevalent complication during RIA reaming. In addition, PPP occurs with a prevalence of 6.45%. This study showed a complication rate of 1.76%, emphasizing RIA´s overall safety and furthermore highlighting the need for vigilance in its application and prior extensive hands-on training of surgeons. Level of Evidence: II.

Citing Articles

Autologous Bone Graft Harvest Technique Using Reamer-Irrigator-Aspirator for 2-Stage Revision Anterior Cruciate Ligament Reconstruction.

Kelly M, Schuck J, Gardner A, Newman J Arthrosc Tech. 2025; 14(2):103236.

PMID: 40041363 PMC: 11873506. DOI: 10.1016/j.eats.2024.103236.

[Modified Masquelet technique for reconstruction of critical bone defects].

Huckstadt M, Fischer C, Mitin M, Klauke F, Langwald S, Mendel T Unfallchirurgie (Heidelb). 2024; 127(10):738-742.

PMID: 39143243 PMC: 11420276. DOI: 10.1007/s00113-024-01473-7.

An in vivo study to investigate an original intramedullary bone graft harvesting technology.

Laubach M, Bessot A, McGovern J, Saifzadeh S, Gospos J, Segina D Eur J Med Res. 2023; 28(1):349.

PMID: 37715198 PMC: 10503043. DOI: 10.1186/s40001-023-01328-8.

Masquelet Technique and Proximal Tibial Autograft Utilizing Avitus® Bone Harvester for Severely Comminuted Open Distal Radius Fracture with Extensive Bone Loss: A Case Report.

Greco V, Hammarstedt J, OConnor S, Regal S J Orthop Case Rep. 2022; 12(4):49-53.

PMID: 36381007 PMC: 9634387. DOI: 10.13107/jocr.2022.v12.i04.2762.

Complications associated using the reamer-irrigator -aspirator (RIA) system: a systematic review and meta-analysis.

Laubach M, Weimer L, Blasius F, Hildebrand F, Kobbe P, Hutmacher D Arch Orthop Trauma Surg. 2022; 143(7):3823-3843.

PMID: 36114869 PMC: 10293355. DOI: 10.1007/s00402-022-04621-z.

References

Younger E, Chapman M . Morbidity at bone graft donor sites. J Orthop Trauma. 1989; 3(3):192-5. DOI: 10.1097/00005131-198909000-00002. View

Higgins T, Casey V, Bachus K . Cortical heat generation using an irrigating/aspirating single-pass reaming vs conventional stepwise reaming. J Orthop Trauma. 2007; 21(3):192-7. DOI: 10.1097/BOT.0b013e318038d952. View

Qvick L, Ritter C, Mutty C, Rohrbacher B, Buyea C, Anders M . Donor site morbidity with reamer-irrigator-aspirator (RIA) use for autogenous bone graft harvesting in a single centre 204 case series. Injury. 2013; 44(10):1263-9. DOI: 10.1016/j.injury.2013.06.008. View

Lowe J, Della Rocca G, Murtha Y, Liporace F, Stover M, Nork S . Complications associated with negative pressure reaming for harvesting autologous bone graft: a case series. J Orthop Trauma. 2009; 24(1):46-52. DOI: 10.1097/BOT.0b013e31819c0ccb. View

Dimitriou R, Mataliotakis G, Angoules A, Kanakaris N, Giannoudis P . Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury. 2011; 42 Suppl 2:S3-15. DOI: 10.1016/j.injury.2011.06.015. View

Stinner D, Mir H . Techniques for intramedullary nailing of proximal tibia fractures. Orthop Clin North Am. 2013; 45(1):33-45. DOI: 10.1016/j.ocl.2013.09.001. View

OLERUD S, Stromberg L . Intramedullary reaming and nailing: its early effects on cortical bone vascularization. Orthopedics. 1986; 9(9):1204-8. DOI: 10.3928/0147-7447-19860901-06. View

Wenda K, Runkel M, Degreif J, Ritter G . Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing--demonstrated by intraoperative echocardiography. Injury. 1993; 24 Suppl 3:S73-81. DOI: 10.1016/0020-1383(93)90011-t. View

Porter R, Liu F, Pilapil C, Betz O, Vrahas M, Harris M . Osteogenic potential of reamer irrigator aspirator (RIA) aspirate collected from patients undergoing hip arthroplasty. J Orthop Res. 2008; 27(1):42-9. PMC: 2648608. DOI: 10.1002/jor.20715. View

10.

Moghaddam A, Sperl A, Heller R, Kunzmann K, Graeser V, Akbar M . Elevated Serum Insulin-Like Growth Factor 1 Levels in Patients with Neurological Remission after Traumatic Spinal Cord Injury. PLoS One. 2016; 11(7):e0159764. PMC: 4957810. DOI: 10.1371/journal.pone.0159764. View

11.

Blum B, Moseley J, Miller L, Richelsoph K, Haggard W . Measurement of bone morphogenetic proteins and other growth factors in demineralized bone matrix. Orthopedics. 2004; 27(1 Suppl):s161-5. DOI: 10.3928/0147-7447-20040102-17. View

12.

Quintero A, Tarkin I, Pape H . Technical tricks when using the reamer irrigator aspirator technique for autologous bone graft harvesting. J Orthop Trauma. 2009; 24(1):42-5. DOI: 10.1097/BOT.0b013e3181b2b4eb. View

13.

McCall T, Brokaw D, Jelen B, Scheid D, Scharfenberger A, Maar D . Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series. Orthop Clin North Am. 2009; 41(1):63-73. DOI: 10.1016/j.ocl.2009.08.002. View

14.

Kanakaris N, Morell D, Gudipati S, Britten S, Giannoudis P . Reaming Irrigator Aspirator system: early experience of its multipurpose use. Injury. 2011; 42 Suppl 4:S28-34. DOI: 10.1016/S0020-1383(11)70009-2. View

15.

Dawson J, Kiner D, Gardner 2nd W, Swafford R, Nowotarski P . The reamer-irrigator-aspirator as a device for harvesting bone graft compared with iliac crest bone graft: union rates and complications. J Orthop Trauma. 2014; 28(10):584-90. DOI: 10.1097/BOT.0000000000000086. View

16.

Hoegel F, Mueller C, Peter R, Pfister U, Suedkamp N . Bone debris: dead matter or vital osteoblasts. J Trauma. 2004; 56(2):363-7. DOI: 10.1097/01.TA.0000047811.13196.02. View

17.

Tosounidis T, Calori G, Giannoudis P . The use of Reamer-irrigator-aspirator in the management of long bone osteomyelitis: an update. Eur J Trauma Emerg Surg. 2016; 42(4):417-423. PMC: 4969338. DOI: 10.1007/s00068-016-0700-7. View

18.

Hannouche D, Petite H, Sedel L . Current trends in the enhancement of fracture healing. J Bone Joint Surg Br. 2001; 83(2):157-64. DOI: 10.1302/0301-620x.83b2.12106. View

19.

Schmidmaier G, Herrmann S, Green J, Weber T, Scharfenberger A, Haas N . Quantitative assessment of growth factors in reaming aspirate, iliac crest, and platelet preparation. Bone. 2006; 39(5):1156-1163. DOI: 10.1016/j.bone.2006.05.023. View

20.

Schult M, Kuchle R, Hofmann A, Schmidt-Brakling T, Ortmann C, Wassermann E . Pathophysiological advantages of rinsing-suction-reaming (RSR) in a pig model for intramedullary nailing. J Orthop Res. 2006; 24(6):1186-92. DOI: 10.1002/jor.20106. View