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Reamer-Irrigation-Aspiration (RIA) system: The Game Changer.
Keywords:
Intramedullary nailing, mesenchymal stem cells, Reamer-Irrigation-Aspiration, debridementAbstract
Intramedullary nailing of long bone fractures have been associated with fat embolism and thermal necrosis due to reaming.1,2 An attempt to reduce the incidence of these complications Reamer-Irrigation-Aspiration(RIA) system was developed (Synthes, Paoli, PA, USA).This innovative system provides simultaneous continuous irrigation and suction while reaming long bones. The marrow contents, bone fragments and irrigation fluid is passed through a filter first and then into a suction bag. The second generation RIA system was launched in 2019 (Fig. I). It has new design for easy handling, small reamer head size of 10 mm (first generation RIA system has 12 mm reamer head size) and has larger holes for improved irrigation and suction. The design and characteristics of this reamer are different from standard reamer and detailed guidelines of RIA technique and usage has already been established.3 The purpose of this editorial is to update the Orthopaedic community of Pakistan about the expanded indications, safety and efficacy of RIA system.
The indications of RIA have been expanded recently. It has been used for treating post operative osteomyelitis,4 non unions of long bone 5-9 and for obtaining mesenchymal stem cells.10 Zalavras4 treated 8 tibial osteomyelitis and 3 femur osteomyelitis with debridement of the medullary canals utilizing RIA system and reported no infection at six months follow up.
References
Glover P, Worthley LI. Fat embolism. Crit Care Resusc 1999;1(3):276-284.
Giannoudis PV, Snowden S, Matthews SJ,Smye SW,Smith RM. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res 2002; 395:255-261.
Giannoudis PV, Tzioupis C, Green J.Surgical techniques: How I do it? The reamer/irrigator/aspirator (RIA) system. Injury 2009; 40(11):1231-1236.
Zalavras CG, Singh A, Patzakis MJ. Novel technique for medullary canal debridement in tibia and femur osteomyelitis. Clin Orthop Relat Res 2007; 461:31-34.
Kobbe P, Tarkin IS, Pape HC.Use of the 'reamer irrigator aspirator' system for non-infected tibial non-union after failed iliac crest grafting. Injury 2008; 39(7):796-800.
Newman JT, Stahel PF, Smith WR, Resende GV, Hak DJ, Morgan SJ.A new minimally invasive technique for large volume bone graft harvest for treatment of fracture nonunions. Orthopedics 2008; 31(3):257-261.
Belthur MV, Conway JD, Jindal G,Ranade A,Herzenberg JE.Bone graft harvest using a new intramedullary system. Clin Orthop Relat Res 2008; 466(12):2973-2980.
McCall TA, Brokaw DS, Jelen BA, Scheid DK, Scharfenberger AV, Maar DC, et al. Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series. Orthop Clin North Am 2010; 41(1):63-73.
Stafford PR, Norris B. Reamer-irrigator-aspirator as a bone graft harvester. Tech Foot Ankle Surg 2007; 6:100-107.
Porter RM, Liu F, Pilapil C, Betz OB, Vrahas MS, Harris MB, et al Osteogenic potential of reamer irrigator aspirator (RIA) aspirate collected from patients undergoing hip arthroplasty. J Orthop Res 2009; 27(1):42-49.
Schmidmaier G, Herrmann S, Green J,Weber T, Scharfenberger A,Hass NP, et al Quantitative assessment of growth factors in reaming aspirate, iliac crest, and platelet preparation. Bone 2006; 39(5):1156-1163.
Hartsock LA, Barfield WR, Kokko KP, Liles LL, Wind T, Green J, et al. Randomized prospective clinical trial comparing reamer irrigator aspirator (RIA) to standard reaming (SR) in both minimally injured and multiply injured patients with closed femoral shaft fractures treated with reamed intramedullary nailing (IMN). Injury 2010;41:94-98.
Dawson J, Kiner D, Ii WG, Swafford R, Nowotarski PJ. The Reamer Irrigator Aspirator as a device for harvesting bone graft compared with iliac crest bone graft: union rates and complications. J Orthop Trauma 2014;28:584–590.
Nichols TA, Sagi HC, Weber TG, Guiot BH. An alternative source of autograft bone for spinal fusion: the femur: technical case report. Neurosurgery 2008;62-66.
Seagrave RA, Sojka J, Goodyear A, Munns SW. Utilizing reamer irrigator aspirator (RIA) autograft for opening wedge high tibial osteotomy: A new surgical technique and report of three cases. Int J Surg Case Rep 2014;5:37–42.
Vincenti G, Bizzoca D, Cotugno D, Carrozzo M, Riefoli F, Rifino F, et al. The use of gentamicin-coated titanium nail, combined with RIA system in the management of non-union of open tibial fractures: A single centre prospective study. Injury 2020;51(3):86-91.
Higgins TF, Casey V, Bachus K.Cortical heat generation using an irrigating/aspirating single-pass reaming vs conventional stepwise reaming. J Orthop Trauma 2007; 21(3):192-197.
Castro-Malaspina H, Gay RE, Resnick G, Kapoor N, Meyers P, Chiarieri D, et al. Characterization of human bone marrow fibroblast colony-forming cells (CFU-F) and their progeny. Blood 1980; 56:289-301
Jones EA, Kinsey SE, English A, Jones RA, Straszynski L, Meredith DM, et al. Isolation and characterization of bone marrow multipotential mesenchymal progenitor cells. Arthritis Rheum 2002; 46(12):3349-3360.
Miller MA, Ivkovic A, Porter R, Harris MB, Estok DM ,Smith RM, et al.Autologous bone grafting on steroids: preliminary clinical results. A novel treatment for nonunions and segmental bone defects. Int Orthop 2010;121-129.
Toosi S, H Naderi-Meshkin H, Kalalinia F, Peivandi MT, Khani HH, Bahrami AR et al. Comparative characteristics of mesenchymal stem cells derived from reamer-irrigator-aspirator, iliac crest bone marrow, and adipose tissue. Cell Mol Biol (Noisy-le-grand) 2016;62(10):68-74.
Kanakaris NK, Morell D, Gudipati S, Britten S, Giannoudis PV. Reaming Irrigator Aspirator system: early experience of its multipurpose use. Injury 2011;42:28-34.
Stafford PR, Norris BL. Reamer-Irrigator-Aspirator bone graft and bi Masquelet technique for segmental bone defect non unions: A review of 25 cases. Injury 2010;41(Suppl 2):72-77.
Dehghan N, Schemitsch EH, Extended applications of the reamer-irrigator-aspirator (RIA) system. Injury 2017;234-249.
Jakma TSC, Roling MA, Punt B, Reynders-Frederix P. More adverse events than expected in the outcome after use of the reamer-irrigator-aspirator. Eur J Trauma Emerg Surg 2013;40:337-341.
Cipriano CA, Arvanitis LD, Virkus WW. Use of the reamer-irrigator-aspirator may reduce tumor dissemination during intramedullary fixation of malignancies. Orthopedics 2012;35:48-52.
Bellapianta J, Gerdeman A, Sharan A, Lozman J. Use of the reamer irrigator aspirator for the treatment of a 20-year recurrent osteomyelitis of a healed femur fracture. J Orthop Trauma 2007;21:343-346.
Marchand LS, Rothberg DL, Kubiak EN, et al. Is this autograft worth it? The blood loss and transfusion rates associated with reamer irrigator aspirator bone graft harvest. J Orthop Trauma 2017;31(4):205-209.
