Skip to main content

Advertisement

SpringerLink
Log in

A radiographic and clinical comparison of reamer–irrigator–aspirator versus iliac crest bone graft in ankle arthrodesis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

We evaluated radiographic fusion at follow-up and complication rates in patients who had either iliac crest (ICBG) or femoral reamer–irrigator–aspirator (RIA) bone graft for tibiotalar fusion.

Methods

We retrospectively reviewed charts and radiographs of all patients who had a tibiotalar fusion from August 2007 to February 2011. Records were analysed for patient demographics, complications, and clinical symptoms. Radiographs were reviewed in sequential order by two fellowship-trained foot and ankle surgeons and one orthopaedic surgeon who specialises in foot and ankle surgery to determine radiographic fusion at routine follow-up. Patients were contacted to determine current visual analog scores (VAS) at their graft site.

Results

Mean patient age was 49.4 ± 12.1 years in the RIA group and 49.3 ± 15.4 years in the ICBG group (p = .97). Pre-operative characteristics showed no significant differences between groups. The ICBG group had significantly more nonunions than the RIA group (six vs. one, p = 0.04). Two patients in the ICBG had chronic pain at their graft site based on their VAS score; there were none in the RIA group. Radiographic fusion at follow-up was similar between groups, with no significant difference (12.48 ± 3.85 weeks vs.12.21 ± 3.19 weeks, p = .80).

Conclusions

There was a significantly higher nonunion rate in the ICBG group, but both groups had a solid radiographic bony fusion at similar follow-up time points. Our results suggest RIA bone graft is a viable alternative to ICBG for tibiotalar fusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gazdag AR, Lane JM, Glaser D, Forster RA (1995) Alternatives to autogenous bone graft: efficacy and indications. J Am Acad Orthop Surg 3:1–8

    PubMed  Google Scholar 

  2. Grabowski G, Cornett CA (2013) Bone graft and bone graft substitutes in spine surgery: current concepts and controversies. J Am Acad Orthop Surg 21:51–60. doi:10.5435/JAAOS-21-01-51

    Article  PubMed  Google Scholar 

  3. Larsson S, Hannink G (2011) Injectable bone-graft substitutes: current products, their characteristics and indications, and new developments. Injury 42(Suppl 2):S30–S34. doi:10.1016/j.injury.2011.06.013

    Article  PubMed  Google Scholar 

  4. Mauffrey C, Seligson D, Lichte P, Pape HC, Al-Rayyan M (2011) Bone graft substitutes for articular support and metaphyseal comminution: what are the options? Injury 42(Suppl 2):S35–S39. doi:10.1016/j.injury.2011.06.012

    Article  PubMed  Google Scholar 

  5. Bauer TW, Muschler GF (2000) Bone graft materials. An overview of the basic science. Clin Orthop Relat Res 371:10–27

  6. Belthur MV, Conway JD, Jindal G, Ranade A, Herzenberg JE (2008) Bone graft harvest using a new intramedullary system. Clin Orthop Relat Res 466:2973–2980. doi:10.1007/s11999-008-0538-3

    Article  PubMed Central  PubMed  Google Scholar 

  7. Quintero AJ, Tarkin IS, Pape HC (2010) Technical tricks when using the reamer irrigator aspirator technique for autologous bone graft harvesting. J Orthop Trauma 24:42–45. doi:10.1097/BOT.0b013e3181b2b4eb

    Article  PubMed  Google Scholar 

  8. Kobbe P, Tarkin IS, Pape HC (2008) Use of the 'reamer irrigator aspirator' system for non-infected tibial non-union after failed iliac crest grafting. Injury 39:796–800. doi:10.1016/j.injury.2007.12.020

    Article  PubMed  Google Scholar 

  9. Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 84-A:716–720

    PubMed  Google Scholar 

  10. Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976) 20:1055–1060

    Article  CAS  Google Scholar 

  11. Ebraheim NA, Elgafy H, Xu R (2001) Bone-graft harvesting from iliac and fibular donor sites: techniques and complications. J Am Acad Orthop Surg 9:210–218

    CAS  PubMed  Google Scholar 

  12. Husebye EE, Lyberg T, Madsen JE, Eriksen M, Roise O (2006) The influence of a one-step reamer-irrigator-aspirator technique on the intramedullary pressure in the pig femur. Injury 37:935–940. doi:10.1016/j.injury.2006.06.119

    Article  PubMed  Google Scholar 

  13. Sagi HC, Young ML, Gerstenfeld L, Einhorn TA, Tornetta P (2012) Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient. J Bone Joint Surg Am 94:2128–2135. doi:10.2106/JBJS.L.00159

    Article  PubMed  Google Scholar 

  14. Porter RM, Liu F, Pilapil C, Betz OB, Vrahas MS, Harris MB, Evans CH (2009) Osteogenic potential of reamer irrigator aspirator (RIA) aspirate collected from patients undergoing hip arthroplasty. J Orthop Res 27:42–49. doi:10.1002/jor.20715

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lehman AA, Irgit KS, Cush GJ (2012) Harvest of autogenous bone graft using reamer-irrigator-aspirator in tibiotalocalcaneal arthrodesis: surgical technique and case series. Foot Ankle Int 33:1133–1138. doi:10.3113/FAI.2012.1133

    PubMed  Google Scholar 

  16. Cox G, McGonagle D, Boxall SA, Buckley CT, Jones E, Giannoudis PV (2011) The use of the reamer-irrigator-aspirator to harvest mesenchymal stem cells. J Bone Joint Surg (Br) 93:517–524. doi:10.1302/0301-620X.93B4.25506

    Article  CAS  Google Scholar 

  17. Kim DH, Rhim R, Li L, Martha J, Swaim BH, Banco RJ, Jenis LG, Tromanhauser SG (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9:886–892. doi:10.1016/j.spinee.2009.05.006

    Article  PubMed  Google Scholar 

  18. Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3–S15. doi:10.1016/j.injury.2011.06.015

    Article  PubMed  Google Scholar 

  19. Moeckel BH, Patterson BM, Inglis AE, Sculco TP (1991) Ankle arthrodesis. A comparison of internal and external fixation. Clin Orthop Relat Res 268:78–83

  20. Monroe MT, Beals TC, Manoli A 2nd (1999) Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws. Foot Ankle Int 20:227–231

    Article  CAS  PubMed  Google Scholar 

  21. Cheng H, Jiang W, Phillips FM, Haydon RC, Peng Y, Zhou L, Luu HH, An N, Breyer B, Vanichakarn P, Szatkowski JP, Park JY, He TC (2003) Osteogenic activity of the fourteen types of human bone morphogenetic proteins (BMPs). J Bone Joint Surg Am 85-A:1544–1552

    PubMed  Google Scholar 

  22. Gerstenfeld LC, Cullinane DM, Barnes GL, Graves DT, Einhorn TA (2003) Fracture healing as a post-natal developmental process: molecular, spatial, and temporal aspects of its regulation. J Cell Biochem 88:873–884. doi:10.1002/jcb.10435

    Article  CAS  PubMed  Google Scholar 

  23. Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243

    Article  CAS  PubMed  Google Scholar 

  24. Loder RT (1988) The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 232:210–216

  25. Funk JR, Hale JE, Carmines D, Gooch HL, Hurwitz SR (2000) Biomechanical evaluation of early fracture healing in normal and diabetic rats. J Orthop Res 18:126–132. doi:10.1002/jor.1100180118

    Article  CAS  PubMed  Google Scholar 

  26. Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM (2005) Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma 19:151–157

    Article  PubMed  Google Scholar 

  27. Al-Hadithy N, Sewell MD, Bhavikatti M, Gikas PD (2012) The effect of smoking on fracture healing and on various orthopaedic procedures. Acta Orthop Belg 78:285–290

    PubMed  Google Scholar 

  28. Qvick LM, Ritter CA, Mutty CE, Rohrbacher BJ, Buyea CM, Anders MJ (2013) Donor site morbidity with reamer-irrigator-aspirator (RIA) use for autogenous bone graft harvesting in a single centre 204 case series. Injury 44:1263–1269. doi:10.1016/j.injury.2013.06.008

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Rohrbacher and Dr. Gurske-dePerio for assistance with radiographic review and Cathy Buyea for assistance with statistical analysis.

Conflict of interest

None.

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedics, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA

    Scott R. Nodzo, Nathan B. Kaplan, Donald W. Hohman & Christopher A. Ritter

Authors
  1. Scott R. Nodzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathan B. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donald W. Hohman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher A. Ritter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott R. Nodzo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nodzo, S.R., Kaplan, N.B., Hohman, D.W. et al. A radiographic and clinical comparison of reamer–irrigator–aspirator versus iliac crest bone graft in ankle arthrodesis. International Orthopaedics (SICOT) 38, 1199–1203 (2014). https://doi.org/10.1007/s00264-014-2348-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2348-4

Keywords

Search

Navigation