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

Orthopaedic Trauma Service, 5 Tampa General Circle, Suite 710, Tampa, FL 33606. E-mail address: .
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 12/2012; 94(23):2128-35. DOI: 10.2106/JBJS.L.00159
Source: PubMed


Donor site morbidity and limited volume remain primary drawbacks of using bone graft from the iliac crest and an impetus for finding other sources of autologous bone-graft material. The Synthes Reamer/Irrigator/Aspirator (RIA) has been found to have value as an autologous bone-graft harvesting device. The purpose of this study was to compare the cellular and biochemical characteristics of bone grafts obtained with use of the RIA and from the iliac crest of the same patient.
A prospective study was performed on a consecutive series of ten skeletally mature patients presenting for repair of nonunited tibial or femoral fractures. Graft material was harvested from both the iliac crest (in the standard fashion) and the medullary canal of the femur or tibia (with use of the RIA) of each patient. Portions of each autologous graft sample were assessed histologically and by genomewide transcriptional profiling for biochemical markers known to be expressed during fracture-healing.
Principal-component analysis comparing the messenger RNA expression profiles in the RIA and iliac crest samples showed that the expression profile at each harvest site was unique and independent of patient, age, sex, or any identified comorbidity. Transcriptional analysis showed that the RIA samples had greater levels of expression of genes associated with vascular, skeletal, and hematopoietic tissues. Additionally, stem cell markers and growth factors that act early in the osteogenic cascade were more abundant in the RIA samples compared with the iliac crest samples.
This is the first study to directly compare the histological and molecular profiles of bone grafts from reaming debris and the iliac crest of the same patient. The debris generated during intramedullary reaming, harvested with use of the RIA technique, and the bone graft harvested from the iliac crest possessed a similar transcriptional profile for genes known to act in the early stages of bone repair and formation. This suggests that reaming debris may be a viable alternative to iliac crest bone graft when autologous cancellous graft is needed.

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    • "In conclusion, our data are in line with other studies showing an increased content of growth factors and osteogenic precursor cells in RIA graft material [5] [7]. These studies have found increased gene expression of musculoskeletal associated genes, higher amounts of growth factors such as bone morphogenic proteins and increased numbers of osteogenic cells. "
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    ABSTRACT: Introduction Donor-site morbidity, complications and availability remain concerns in autologous bone grafting today. The Reamer/Irrigator/Aspirator system (RIA) provides an alternative method to overcome these problems. According to literature, RIA graft possesses a higher osteogenic potency. This study compares iliac crest and RIA graft performance by determining their in vitro osteogenic capacity in a porcine model. Methods Osteogenic capacity and cell content was determined in RIA and iliac crest bone grafts harvested from six female domestic white pigs. Cells initially washed off, and cells harvested with collagenase were analyzed separately and in combination. Alkaline phosphatase expression (ALP) and cell numbers were evaluated after 7 and 14 days of culture. Matrix mineralization was quantified after 14 days. Results Cell cultures showed a significant increase of matrix mineralization by RIA-derived cells compared to iliac crest bone graft (p = 0.0313). The yield of collagenase derived cells was increased in the RIA group and a synergy between washed off and collagenase derived cells was observed. Cell proliferation was similar in both groups. Discussion The osteogenic differentiation capacity of cell populations isolated from the RIA derived bone graft surpasses that of iliac crest derived cells. It is proposed that the observed effect can be attributed to the origin of the cells and to the specific action of the RIA system. This study provides further evidence indicating that RIA bone graft provides superior osteogenic properties compared to iliac crest bone graft.
    Injury 10/2014; 45(12). DOI:10.1016/j.injury.2014.10.009 · 2.14 Impact Factor
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    • "Intramedullary autologous bone grafts have been shown to yield comparable results regarding stiffness, bone healing and osteoinductive factors when compared to bone grafts from the iliac crest [21]. In a recent prospective study, Sagi et al. [22] showed reduced donor site morbidity for RIA compared to iliac crest grafts. Only limited data is available on how autologous bone grafting harvested by RIA promotes fracture healing [21]. "
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    ABSTRACT: Background Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult. To the author’s best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient. Case presentation A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications. Conclusions Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected.
    BMC Musculoskeletal Disorders 06/2014; 15(1):202. DOI:10.1186/1471-2474-15-202 · 1.72 Impact Factor
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    ABSTRACT: In traumatologia e ortopedia, l’innesto di tessuto osseo viene frequentemente effettuato per facilitare la rigenerazione ossea. L’innesto di osso autologo è tuttora il “gold standard” e il sito di prelievo più comune rimane la cresta iliaca. La recente introduzione di un nuovo “device”, il “reamer irrigator aspirator” (RIA), consente di prelevare tessuto osseo autologo dal canale intramidollare delle ossa lunghe, e in particolare del femore. Obiettivo del presente studio è descrivere le proprietà biologiche del tessuto osseo autologo ottenuto mediante RIA e discuterne le potenziali applicazioni e i risultati clinici nel “setting” di una insufficiente guarigione ossea dopo una frattura.
    Archivio di Ortopedia e Reumatologia 12/2013; 124(1-3). DOI:10.1007/s10261-013-0047-0
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