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Laubach M, Weimer LP, Bläsius FM, Hildebrand F, Kobbe P, Hutmacher DW. Complications associated using the reamer-irrigator -aspirator (RIA) system: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:3823-3843. [PMID: 36114869 PMCID: PMC10293355 DOI: 10.1007/s00402-022-04621-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Complications associated with the application of the Reamer-irrigator-Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted. MATERIALS AND METHODS The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system. RESULTS Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2-3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00-6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80-26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69-4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed. CONCLUSIONS The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.
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Affiliation(s)
- Markus Laubach
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000 Australia
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Lucas P. Weimer
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Felix M. Bläsius
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Dietmar W. Hutmacher
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000 Australia
- Australian Research Council (ARC) Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology (QUT), Brisbane, QLD 4000 Australia
- Max Planck Queensland Center for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4000 Australia
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Deininger C, Wagner A, Heimel P, Salzer E, Vila XM, Weißenbacher N, Grillari J, Redl H, Wichlas F, Freude T, Tempfer H, Teuschl-Woller AH, Traweger A. Enhanced BMP-2-Mediated Bone Repair Using an Anisotropic Silk Fibroin Scaffold Coated with Bone-like Apatite. Int J Mol Sci 2021; 23:283. [PMID: 35008718 PMCID: PMC8745248 DOI: 10.3390/ijms23010283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022] Open
Abstract
The repair of large bone defects remains challenging and often requires graft material due to limited availability of autologous bone. In clinical settings, collagen sponges loaded with excessive amounts of bone morphogenetic protein 2 (rhBMP-2) are occasionally used for the treatment of bone non-unions, increasing the risk of adverse events. Therefore, strategies to reduce rhBMP-2 dosage are desirable. Silk scaffolds show great promise due to their favorable biocompatibility and their utility for various biofabrication methods. For this study, we generated silk scaffolds with axially aligned pores, which were subsequently treated with 10× simulated body fluid (SBF) to generate an apatitic calcium phosphate coating. Using a rat femoral critical sized defect model (CSD) we evaluated if the resulting scaffold allows the reduction of BMP-2 dosage to promote efficient bone repair by providing appropriate guidance cues. Highly porous, anisotropic silk scaffolds were produced, demonstrating good cytocompatibility in vitro and treatment with 10× SBF resulted in efficient surface coating. In vivo, the coated silk scaffolds loaded with a low dose of rhBMP-2 demonstrated significantly improved bone regeneration when compared to the unmineralized scaffold. Overall, our findings show that this simple and cost-efficient technique yields scaffolds that enhance rhBMP-2 mediated bone healing.
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Affiliation(s)
- Christian Deininger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (F.W.); (T.F.)
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
| | - Patrick Heimel
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Elias Salzer
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Xavier Monforte Vila
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Nadja Weißenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
| | - Johannes Grillari
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
- Department of Biotechnology, Institute of Molecular Biotechnology, BOKU-University of Natural Resources and Life Sciences, 1180 Vienna, Austria
| | - Heinz Redl
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
| | - Florian Wichlas
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (F.W.); (T.F.)
| | - Thomas Freude
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (F.W.); (T.F.)
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
| | - Andreas Herbert Teuschl-Woller
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
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