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Reaming system may help clinicians use new source of bone graft materials

The system might help treat patients with large defects or where harvesting iliac crest bone is not indicated.

Issue: Issue 4 2006

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CHICAGO — Using a special reaming device may eventually help orthopaedic surgeons less invasively harvest bone grafting materials that contain about the same type and number of growth factors that exist in iliac crest bone graft.

German and American researchers recently collaborated on a small 7-patient study to quantitatively assess the growth factors in reaming aspirate harvested with a special reamer irrigator aspirator (RIA) system and in the corresponding irrigation fluid. The point of the study: to compare growth factors in the aspirate to those in reaming irrigation fluid, iliac crest bone graft, platelet-rich plasma (PRP) and platelet-poor plasma (PPP).

They used a Coomassie Plus Protein Assay and enzyme-linked immunosorbent assay tests to quantify the protein concentration of 8 growth factors, including 2 bone morphogenetic proteins (BMP), insulin-like growth factor-1 (IGF-1), transforming growth factor-beta 1 (TGF-1), vascular endothelial growth factor (VEGF), fibroblast growth factor- and – (FGF), and platelet-derived growth factor- (PDGF).

Britt Wildemann, PhD, at the Center for Musculoskeletal Surgery, Charité University of Medicine, Berlin and Humboldt University, Berlin, presented results at the Orthopaedic Research Society’s Annual Meeting.

Harvest procedure

Synthes manufactures the RIA system, which consists of a 13-mm cannulated drill bit, according to the abstract. Surgeons used it to create an entry point in the patient’s femur and then passed a 2.5-mm ball tip guide rod into the intramedullary canal. During the harvest process, they attached a saline bag to the irrigation port with suction to filter and collect the reaming irrigation fluid. They performed two to four passes with the RIA system during each harvest procedure.

“The reaming can be used to harvest large amounts of bony material,” she explained. “This bony material contains growth factors, and they occur in a comparable amount as in the iliac crest and, therefore, we might find that this material is an alternative graft material, especially in patients who are not allowed to have iliac crest harvested.”

Levels quantified

Compared to iliac crest material, the reaming aspirate contained higher levels of FGF-, PDGF, IGF-1, BMP-2 and TGF-1, but researchers found greater amounts of FGF- and VEGF in the iliac crest samples vs. the aspirate.

According to the abstract, the reaming irrigation contained higher levels of FGF- and – than did the PRP, suggesting the reaming aspirate and irrigation might prove effective bone healing.

A prospective clinical trial involving the RIA system is under way to treat patients who have large bone defects or have undergone multiple bone grafting surgeries, the abstract said. “No complications have occurred referent to the RIA technique,” investigators wrote.

“Further in vitro and in vivoexperiments need to be done to look at this bony material,” Wildemann said.

For more information:

• Schmidmaier G, Herrmann S, Green J, et al. Quantitative assessment of growth factors in reaming aspirate, iliac crest, PRP and PPP. #150. Presented at the Orthopaedic Research Society’s Annual Meeting. March 19-22, 2006. Chicago.