A review on application and complications associated with Reamer Irrigator Aspirator (RIA) and RIA2 in autologous bone graft harvest

Abstract

Background and Literature Review: The Reamer-Irrigator-Aspirator (RIA) and RIA2 system have been gaining popularity for their application in autologous bone graft harvest, followed by intramedullary canal clearance and nail fixation in the past two decades. However, there have been only few studies on the use of newer RIA2 system. Current literature suggests that the prevalence of complications associated with RIA system varied from 0.7% to 11.9%. Among those complications, cortex perforation is the most commonly reported, followed by cardiopulmonary complications, wound infection, low energy fracture, and RIA device failure. In this study, we also illustrated a rare complication of device failure—breakage of reamer head with metallic debris retention in RIA2. Illustrative Case: The RIA2 system was used for autologous bone graft harvest in a young overweight man with significant tibial bone defect. During the harvest procedure, the reamer head broke in the femoral canal. There were retained metallic prongs inside the canal, which were retrieved and removed by different devices. Conclusion: The usage, efficacy, and safety of RIA and RIA2 system are deemed promising with proper indication, patient selection, and judicious surgical technique. Broken reamer head with retained metal debris is a rarely reported complication in RIA2 system. Mechanical, implant and patient factors possibly contribute to this complication. Preventive recommendations are also discussed in this study.