Use of the Reamer-Irrigator-Aspirator for cancellous bone graft harvesting directly from non-union sites: A novel approach in femoral and tibial shaft reconstruction.

Abstract

The aim of this study was to assess the safety and the union rate when cancellous bone graft was harvested directly from non-union site using the Reamer-Irrigator-Aspirator (RIA) in femoral and tibial non-unions with intramedullary nail (IMN) fixation. Our hypothesis was that harvesting from the same site would yield similar results to the conventional RIA technique in terms of union and complication rates, with a single reaming thus restricting the morbidity to a single site. Data was retrospectively analyzed from a single tertiary care center. We included 116 reconstruction surgeries in 116 patients, performed between January 1st 2015 and January 31st 2023. Seventy-one were mechanical non-unions (61.2 %) while forty-five were attributable to a septic origin (38.8 %). Patients went through either a one or two-step procedure depending on their infectious status. The mean age at inclusion was 40.6 years (SD = 17.1) with 81.0 % of patients being males (n = 94). The mean follow-up was 41.2 months (SD = 27.9). Out of the 116 non-unions, 105 (90.5 %) had radiological union at last follow-up. Mean union duration was 7.8 months (SD = 4.0), with 56.9 % of patients resuming physical activities and 70 % returning to their previous occupation. Mean Lower Extremity Functional Scale was 56.2 points (SD = 20.9). Succes rate for mechanical non-unions was 93.0 % versus 88.7 % for septic non-unions (p = 0.33). Debridement, antibiotics and implant retention (DAIR) was necessary for 14 patients and sufficient to cure 9 out of 14. No septic shock, no tibial/femoral fracture and no embolism were noted. When done according to our protocol, harvesting cancellous bone graft directly from non-union site using the RIA system is a safe technique, with high union rate and great functional recovery.