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Bone graft harvesting using the RIA (reaming irrigation aspirator) system – a quantitative assessment

Intramedulläre Knochenmarksgewinnung unter Verwendung des RIA (reaming irrigation aspirator) Systems – eine quantitative Bestimmung

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Zusammenfassung

HINTERGRUND: Die autologe Knochenmarksentnahme gilt noch immer als Goldstandard für die Behandlung von Pseudarthrosen. Mit der intramedullären Knochenmarksentnahme steht eine Alternative zu bisher verwendeten Verfahren wie der Beckenkammentnahme oder der Implantierung von synthetischen Materialien für die Behandlung von Knochendefekten zur Verfügung. Das RIA System, welches mit Bohr und Saugvorrichtung übersetzt werden kann, ist ein System welches den intramedullären Druck senkt und so das Risiko einer Fettembolie deutlich reduziert. Das Ziel der vorliegenden Studie ist die Quantifizierung des gewonnenen intramedullären Knochenmarkes und der Vergleich zu bereits publizierten Daten für die Beckenkammentnahme. METHODE: Acht Leichen (7 männlich, 1 weiblich, 16 Extremitäten) mit einem durchschnittlichen Alter von 68 Jahren (49 bis 79) wurden für die vorliegende Studie verwendet. Die Markraumbohrung wurde in allen acht Leichen mit zwei verschiedenen Bohrköpfen der Stärke 12 und 14 mm durchgeführt. Über einen parapatellaren medialen Zugang, wurde die Tibia antegrad und das Femur retrograd aufgebohrt. ERGEBNISSE: Eine signifikant größere Menge an intramedullärem Knochenmaterial (27 ± 12 g) wurde aus dem Femur im Vergleich zu (17 ± 9 g) aus der Tibia gewonnen (p = 0,007). Es konnte keine signifikante Korrelation mit Alter, Geschlecht, Körpergewicht, Knochenlänge oder BMI erzielt werden. KONKLUSION: Unter Betrachtung unseres Ergebnisses, stellt das RIA System eine innovative Technik zur Knochenmarksgewinnung für Rekonstruktionen der unteren Extremität dar. Eine signifikant größere Menge an Knochenmark wurde aus dem Femur im Vergleich zur Tibia gewonnen (p = 0,007). Eine signifikante Korrelation mit Alter, Geschlecht, Körpergewicht, Knochenlänge oder BMI konnte nicht erzielt werden. Mit unserer Studie konnte nachgewiesen werden, dass mit dem RIA-System eine ausreichende Menge an intramedullärem Knochenmark gewonnen werden kann.

Summary

INTRODUCTION: Autologous bone graft is still considered to be the gold standard for treating non-unions in trauma and orthopedic surgery. Intramedullary bone graft harvest appears to be an alternative to other bone graft options such as iliac crest bone graft and synthetic bone substitutes. A one-step reamer-irrigator-aspirator (RIA) system has been developed to reduce the intramedullary pressure and, as a consequence, minimize the risk of fat embolization. The purpose of this study was to determine whether the quantity of harvested intramedullary bone graft is comparable to the quantity of graft that was harvested from the iliac crest in other studies. The aim of the present study was to quantify harvested bone marrow and to compare our results to already published data. METHODS: Eight human cadavers (7 males, 1 female, and 16 limbs) with an average age of 68 years (range, 49–79 years) were obtained for this study. Intramedullary reaming was performed in the tibiae and femora of each cadaver. Two different sizes (12- and 14-mm diameter) of the RIA system were used. After a medial parapatellar incision was made at the knee, antegrade and retrograde reaming were performed in the tibiae and femur to harvest bone graft. RESULTS: A significantly greater quantity of bone graft was harvested from the femora (27 ± 12 g) than the tibiae (17 ± 9 g) (p = 0.007). CONCLUSIONS: On the basis of our present results, harvesting intramedullary bone graft with the RIA system appears to be an innovative technique for bone grafting in limb reconstruction. A significantly greater quantity of bone graft was harvested from the femora than the tibiae (p = 0.007). No significant differences among age, sex, body weight, bone length, or BMI were observed. Our results showed that a sufficient quantity in weight of autogenous bone graft could be obtained using the RIA system.

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  1. Department of Traumatology, General Hospital Vienna, Medical University Vienna, Vienna, Austria

    Florian M. Kovar & Gerald E. Wozasek

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  1. Florian M. Kovar
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  2. Gerald E. Wozasek
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Correspondence to Gerald E. Wozasek.

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Kovar, F., Wozasek, G. Bone graft harvesting using the RIA (reaming irrigation aspirator) system – a quantitative assessment. Wien Klin Wochenschr 123, 285–290 (2011). https://doi.org/10.1007/s00508-011-1565-8

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