title: Retrograde Versus Antegrade Femoral Bone Graft Harvesting Using the Reamer-Irrigator-Aspirator.
abstract: OBJECTIVE
  To compare retrograde versus antegrade femoral bone graft harvesting using the reamer-irrigator-aspirator system to determine whether there was any difference in intraoperative, postoperative, or patient outcome variables.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Urban Level I Trauma Center.
  
  
  METHODS
  Ninety-four (62 antegrade and 32 retrograde procedures) consecutive adult patients who underwent femoral autologous bone graft harvesting using the Synthes reamer-irrigator-aspirator system between April 2008 and March 2013.
  
  
  METHODS
  Amount of bone graft, perioperative fractures or other complications, and postoperative hip and/or knee pain.
  
  
  RESULTS
  There was no significant difference between demographic or medical comorbidities between the groups. There was no significant difference in the side of the graft harvest, graft volume, hospital length of stay, or the ability to ambulate on postoperative day 1. There was a significantly increased incidence of iatrogenic fracture or prophylactic nailing with antegrade reaming (4 vs. 0, P = 0.01). Average length of follow-up was 500 (range, 20-1477) days for the antegrade group and 378 (range, 19-706) days for the retrograde group. The antegrade group had a nonsignificant increased incidence of hip pain (8.1% vs. 3.1%, P = 0.66), and the retrograde group had a significantly higher incidence of knee pain (15.6% vs. 1.6%, P = 0.02) at 6-month follow-up. Neither hip nor knee complaints were present at final follow-up. No cases of delayed femur fracture, infection, or abductor and/or antalgic gait involving the donor extremity were seen at final follow-up.
  
  
  CONCLUSIONS
  This study provides support to the safety of femoral bone graft harvesting using both antegrade and retrograde techniques. Both techniques provide reliable, high-volume, nonstructural autologous bone graft with minimal associated morbidity.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors: *Department of Orthopedic Surgery, Mount Carmel Health, Columbus, OH; and †Department of Orthopaedic Surgery, Grant Medical Center, Columbus, OH.
authors: Richard L
authors: RL
authors: Davis
authors: Benjamin C
authors: BC
authors: Taylor
authors: Nathan
authors: N
authors: Johnson
authors: Jason R
authors: JR
authors: Ferrel
authors: Joaquin
authors: J
authors: Castaneda
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D016025:Bone Transplantation / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D004867:Equipment Design; D005260:Female; D005269:Femur / Q000601:surgery*; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013396:Suction / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome