Reamer-irrigator-aspirator reamings biologically equal to iliac crest bone grafts

Issue: February 2015

KOLOA, Hawaii — Reamer-irrigator-aspirator bone grafts can be used similarly to iliac crest bone grafts for the treatment of knee and hip fractures, according to a presenter at Orthopedics Today Hawaii 2015.

“The bottom line is that [reamer-irrigator-aspirator] RIA works as iliac crest graft. It is identical in volume and consistency. Biologically, you can use it,” Roy W. Sanders, MD, said here.

Iliac crest bone graft is the absolute gold standard for bone graft, according to Sanders. There is no disease transmission, no immune response and ample supply; however, it may cause complications, such as pain, bleeding and patient discomfort.

Roy W. Sanders

Sanders said he uses RIA bone grafts for nonunion, bone defects and arthrodesis. In using the Masquelet technique, a cement spacer protects the cavity from fibrous tissue and stimulates formation of a membrane that releases bone morphogenetic proteins.

Potential benefits of reaming include increased stability and periosteal flow, improved healing, and decreased malunions and non-unions. The problems with reaming are that it causes thermal necrosis and medullary pressurization, and it can weaken bone. However, RIA obviates thermal problems, and aspiration protects from marrow emboli, according to Sanders.

“If it irrigates and aspirates, does it prevent healing by removing the marrow reamings? The answers is no. In fact, it enhances it,” he said. “It enhances it for a number of reasons. One is because it causes the periosteal secondary reaction.” – by Kristine Houck, MA, ELS

Reference:

Sanders RW. Autologous bone graft: RIA harvesting the way to go. Presented at: Orthopedics Today Hawaii 2015; Jan. 18-22, 2015; Koloa, Hawaii.

Disclosure: Sanders is a paid consultant for Smith & Nephew and receives royalties for the Trigen Intramedullary Nail System, the Intertan Hip System, the Jet-X External Fixation System and Sureshot Distal Targeting.