Session I - Polytrauma / Pelvis / Post-Traumatic Reconstruction

Thurs., 10/10/13 Polytrauma/Pelvis/Post-Trauma, PAPER #37, 4:29 pm OTA 2013

The Reamer Irrigator Aspirator (RIA) as a Device for Harvesting Bone Graft Compared With Iliac Crest Bone Graft: Union Rates and Complications

Peter J. Nowotarski, MD; John Dawson, MD; Dirk Kiner, MD; Warren Gardner II, MD;
Rachel Swafford, MS;
University of Tennessee College of Medicine – Chattanooga, Chattanooga, Tennessee, USA

Purpose: This study was performed to determine if patient outcomes after reamer irrigator aspirator (RIA)–harvested bone grafting are inferior, equivalent, or better than outcomes for patients treated with the current gold standard, either anterior or posterior iliac crest graft (ICG).

Methods: 133 patients with nonunion or posttraumatic segmental bone defect requiring surgical intervention were prospectively randomized to receive ICG or RIA autograft. Supplemental internal fixation was performed per surgeon preference. Surgical data included amount of graft, time of harvest, and associated surgical costs. The Short Musculoskeletal Functional Assessment (SMFA) and the visual analog scale (VAS) were used to document baseline and postoperative function and pain. Clinical and radiographic union was the defined end point; patients developing infection or nonunion requiring reoperation on the grafted extremity were considered to have failed the index treatment.

Results: 113 of 133 enrolled patients were followed until union and included in the final analysis. Intraoperative data showed anterior ICG to yield 20.7 ± 12.8 cc (range, 5-60) of autograft with an average harvest time of 33.2 ± 16.2 minutes; posterior ICG yielded 36.1 ± 21.3 cc (range, 20-100) of autograft in 40.6 ± 11.2 minutes; and RIA yielded 37.7 ± 12.9 cc (range, 5-90) in 29.4 ± 15.1 minutes. Anterior ICG produced significantly less bone graft than either RIA or posterior ICG (P <0.001). The RIA harvest took a significantly shorter duration of operative time compared to posterior ICG (P = 0.005). Anterior ICG did not differ in duration of harvest from either RIA or posterior ICG. At $738, the RIA setup was considerably more expensive than the $100 cost of a bone graft tray; however, when compared to posterior ICG, the longer operative time required for a posterior harvest came at an additional incremental cost of $1780, making RIA the less expensive option. Patients were followed for an average of 56.9 ± 42.1 (range, 11-250) weeks. 49 of 57 patients (86.0%) who received ICG united in an average of 22.5 ± 13.2 weeks; 46 of 56 patients (82.1%) who received RIA healed in an average of 25.8 ± 17.0 weeks. Union rates and time to union were equivalent comparing both procedures. There was no difference in complications requiring reoperation for persistent nonunion or infection. Postoperative follow-up showed that RIA patients had significantly lower donor site pain scores throughout follow-up. There was no difference in donor site complications.

Conclusion: When compared to autograft obtained from the iliac crest, autograft harvested using the RIA technique achieves similar union rates with significantly less donor site pain. RIA also yields a greater volume of graft compared to anterior ICG and has a shorter harvest time compared to posterior ICG. For larger-volume harvests, cost analysis favors using RIA.

Funding: This study was partially funded by the Southeast Fracture Consortium. RIA setups were provided by Synthes for the study free of charge.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.