• R Pfeifer, P Kobbe, M Knobe, and H-C Pape.
• Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. rpfeifer@ukaachen.de
• Oper Orthop Traumatol. 2011 Dec 1;23(5):446-52.

ProblemAutologous 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.SolutionThe 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.Surgical TechniqueThe 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.Postoperative ManagementCautious ambulation on the 2nd postoperative day. In case of excessive bone thinning of the femur, partial weight bearing for 4-6 weeks is recommended.ResultsThe 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).

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