title: [The reamer-irrigator-aspirator (RIA) System].
abstract: OBJECTIVE
  Autologous bone transplantation is a treatment of choice in patients with large bone defects. However, the iliac crest bone graft harvest is associated with numerous limitations: low volume of graft, long operation times, acute and chronic pain.
  
  
  METHODS
  The reamer-irrigator-aspirator (RIA) system is used to harvest large volumes of intramedullar bone graft for surgical procedures that require bone graft, including non-unions, delayed union, and bone loss.
  
  
  METHODS
  The RIA device should be assembled prior to the surgical procedure. The greater trochanter is used as entry point. Following the opening of the trochanteric region, a guide wire should be centrally positioned within the bone canal. Frequent fluoroscopic evaluation should be performed to assure the central position of the guide wire. Apply the advance/withdraw/pause/advance technique to maximize irrigation flow through the RIA. The guide wire could be placed in newly desired position within the condyle of the femur if more bone graft is required. While reaming, monitor the reaming head passage on both the anteroposterior and lateral planes to avoid bone perforation or excessive thinning. Remove the intramedullary bone graft from the graft filter.
  
  
  METHODS
  Cautious ambulation on the 2nd postoperative day. In case of excessive bone thinning of the femur, partial weight bearing for 4-6 weeks is recommended.
  
  
  RESULTS
  The RIA system allows large amounts (25-90 cm3) of high quality bone graft to be harvested. This alternative technique is associated with less donor site morbidity and lower rates of minor and major complications when compared with conventional harvest methods (iliac crest).
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. rpfeifer@ukaachen.de
authors.forename: R
authors.initials: R
authors.lastname: Pfeifer
authors.forename: P
authors.initials: P
authors.lastname: Kobbe
authors.forename: M
authors.initials: M
authors.lastname: Knobe
authors.forename: H-C
authors.initials: HC
authors.lastname: Pape
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D010027:Osteotomy / Q000295:instrumentation*; D013396:Suction / Q000295:instrumentation*; D018511:Systems Integration; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation*
references.citation: Clin Orthop Relat Res. 1995 Jun;(315):34-47
references.pmid: 7634684
references.citation: J Orthop Trauma. 2010 Aug;24(8):e81; author reply e81-2
references.pmid: 20657243
references.citation: J Trauma. 2001 Jan;50(1):65-69; discussion 69-70
references.pmid: 11231672
references.citation: J Bone Joint Surg Am. 1997 Mar;79(3):334-41
references.pmid: 9070520
references.citation: J Orthop Res. 2004 Nov;22(6):1271-5
references.pmid: 15475208
references.citation: J Trauma. 2010 Oct;69(4):E6-14
references.pmid: 20489666
references.citation: Injury. 1987 May;18(3):177-9
references.pmid: 3508845
references.citation: J Orthop Trauma. 2007 Mar;21(3):192-7
references.pmid: 17473756
references.citation: Bone. 2005 Jan;36(1):74-83
references.pmid: 15664005
references.citation: Unfallchirurg. 2008 Jun;111(6):469-72
references.pmid: 18273594
references.citation: J Bone Joint Surg Br. 2004 May;86(4):556-60
references.pmid: 15174553
references.citation: Clin Orthop Relat Res. 2000 Apr;(373):295-303
references.pmid: 10810490
references.citation: Bone. 2006 Nov;39(5):1156-1163
references.pmid: 16863704
references.citation: Clin Orthop Relat Res. 1996 Aug;(329):300-9
references.pmid: 8769465
references.citation: Clin Orthop Relat Res. 2008 Dec;466(12):2973-80
references.pmid: 18841433
references.citation: Orthop Clin North Am. 2010 Jan;41(1):99-103; table of contents
references.pmid: 19931058
references.citation: Z Orthop Ihre Grenzgeb. 2003 Jul-Aug;141(4):481-6
references.pmid: 12929008
references.citation: Arch Orthop Trauma Surg. 1998;117(1-2):35-8
references.pmid: 9457333
references.citation: J Trauma. 2003 Sep;55(3):495-503; discussion 503
references.pmid: 14501893
references.citation: Orthop Clin North Am. 2010 Jan;41(1):75-84; table of contents
references.pmid: 19931055
references.citation: Injury. 2008 Jul;39(7):796-800
references.pmid: 18541244
references.citation: J Orthop Trauma. 2010 Jan;24(1):46-52
references.pmid: 20035178
references.citation: Injury. 2009 Nov;40(11):1231-6
references.pmid: 19783249