Autograft harvested using the Reamer-Irrigator-Aspirator technique achieved similar union rates as iliac crest bone graft with significantly less donor-site pain, according to study results.
Researchers randomly assigned 133 patients with nonunion or posttraumatic segmental bone defect requiring operative intervention to receive iliac crest bone graft (ICBG) or Reamer-Irrigator-Aspirator (RIA) autograft. Operative data included amount of graft, time of harvest and associated surgical costs
The researchers used the Short Musculoskeletal Functional Assessment and VAS scores to document baseline and postoperative function and pain. The study end points included clinical and radiographic union, and treatment failure was defined as patients who developed an infection requiring operative treatment or had a persistent nonunion of the grafted extremity.
According to intraoperative data, anterior ICBG yielded 20.7 cm3 of autograft with an average harvest time of 33.2 minutes, whereas posterior ICBG yielded 36.1 cm3 autograft in 40.6 minutes and RIA yielded 37.7 cm3 in 29.4 minutes.
Compared with RIA or posterior ICBG, anterior ICBG produced significantly less bone graft. The researchers also found RIA harvest was completed in significantly less operative time vs. posterior ICBG.
Although the $738 RIA setup was considerably more expensive than the approximate $100 cost of a bone graft tray, the longer operative time required for a posterior ICBG harvest came at an additional incremental cost of $990 to $1,880.
Of the 57 patients who received ICBG, 86% achieved union at an average of 22.5 weeks, whereas 82.1% of patients who received RIA healed in an average of 25.8 weeks.
Union rates and time to union were comparable between the two procedures, no difference was found in complications requiring reoperation of persistent nonunion or infection at the grafted site, and there were no differences in donor-site complications, according to the researchers.
Additionally, throughout follow-up, RIA patients had significantly lower donor-site pain scores.
Disclosure: Nowotarski is a paid consultant for Synthes.