Autologous intramedullary bone graft harvesting as an alternative to conventional harvesting methods

Abstract

Conventional bone graft harvesting using the iliac crest is often cited as having significant donor site morbidity and complications. A technique has become available in the form of intramedullary harvesting, using a reamer- irrigation-aspiration (RIA) system. It is hailed as a safe alternative, with minimal donor site morbidity and pain. This study presents a retrospective case series of 16 patients where the RIA system was used as a harvesting technique from June 2008 to January 2010. This technique involves harvesting autograft from the femoral canal (anterograde or retrograde) by reaming the intramedullary cavity only once. A single surgeon performed the operations over a 24-month period. Fluoroscopy was used to size and measure the width of the canal and to confirm guide wire placement. Outcomes evaluated were post-operative pain perception and patient satisfaction. Bone harvest volumes, intra- and post-operative complications and bony union were noted. Telephonic interviews were conducted in all 16 cases. The average age of the patients was 31 years (15–55 years). The femoral canal was used as the donor site in all the patients. The mean post-operative follow-up period was 18.8 months (8–27 months). The average amount of bone harvested was 39.6 cc (20–70 cc). Two technical complications were encountered intra-operatively and there were no systemic complications due to reaming. Although immediate post-operative pain was significant, all patients interviewed reported no or minimal pain at the harvest site with long-term follow-up. The RIA system was found to be a safe technique, with reliable volumes of autograft obtained. Patients recovered quickly without wound complications and minimal donor-site morbidity. This technique seems to be a viable option as an alternative to conventional bone graft harvesting. Ethical clearance was obtained from The Research Ethics Committee, Faculty of Health Sciences, University of Pretoria.