Use of the Reamer-Irrigator-Aspirator for Bone Graft Harvest: A Mechanical Comparison of Three Starting Points in Cadaveric Femurs

Objectives: The mechanical behavior of cadaveric femurs after intramedullary reaming using the Reamer-Irrigator-Aspirator (RIA) for autogenous bone graft harvest has not been fully described. We hypothesized that reamed femurs, regardless of starting point, would adequately withstand cyclic loading simulating postoperative single-leg stance. Methods: Twenty-one cadaveric pairs were randomly assigned to one of three groups based on starting point: Group I (trochanteric), Group 2 (piriformis fossa), and Group 3 (retrograde). Each femur underwent dual-energy x-ray absorptiometry scanning and radiographs. Each test femur was reamed to 15 mm using the RIA with the contralateral femur serving as the control. The specimens were loaded to 1400 N of axial compression with 2 degrees simultaneous torsion for 10,000 cycles. If the femur survived cyclic loading, it was then loaded to failure in axial compression. Comparisons regarding survival of cyclic loading were made using Fisher exact test. Results: No differences were seen between groups regarding age, sex, and T-score. The mean T-score for the femurs was -2.531 +/- 1.372. Overall, 18 of 21 (86%) test femurs and 20 of 21 (95%) control femurs withstood cyclic loading (P = 0.606). Statistical significance was not reached for the three pairwise comparisons between test groups. The femurs failed in patterns consistent with simple pertrochanteric, basicervical, midcervical, or subcapital fractures. Conclusions: Intramedullary reaming for bone graft harvest using the RIA without subsequent intramedullary stabilization did not significantly degrade the mechanical behavior of cadaveric femurs in simulated single-leg stance regardless of reamer starting point. It appears safe to allow single-leg stance weightbearing on a reamed, unstabilized femur after bone graft harvesting using the RIA.