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Bone Joint J. 2013 Sep;95-B(9):1269-74. doi: 10.1302/0301-620X.95B9.31756.

The viability of cells obtained using the Reamer-Irrigator-Aspirator system and in bone graft from the iliac crest.

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  • 1Medical College of Wisconsin, Department of Orthopaedic Surgery, 8701 Watertown Plank Road, Milwaukee, Wisconsin 53226, USA.


We hypothesised that cells obtained via a Reamer-Irrigator-Aspirator (RIA) system retain substantial osteogenic potential and are at least equivalent to graft harvested from the iliac crest. Graft was harvested using the RIA in 25 patients (mean age 37.6 years (18 to 68)) and from the iliac crest in 21 patients (mean age 44.6 years (24 to 78)), after which ≥ 1 g of bony particulate graft material was processed from each. Initial cell viability was assessed using Trypan blue exclusion, and initial fluorescence-activated cell sorting (FACS) analysis for cell lineage was performed. After culturing the cells, repeat FACS analysis for cell lineage was performed and enzyme-linked immunosorbent assay (ELISA) for osteocalcin, and Alizarin red staining to determine osteogenic potential. Cells obtained via RIA or from the iliac crest were viable and matured into mesenchymal stem cells, as shown by staining for the specific mesenchymal antigens CD90 and CD105. For samples from both RIA and the iliac crest there was a statistically significant increase in bone production (both p < 0.001), as demonstrated by osteocalcin production after induction. Medullary autograft cells harvested using RIA are viable and osteogenic. Cell viability and osteogenic potential were similar between bone grafts obtained from both the RIA system and the iliac crest.


Autogenous bone grafting; Iliac crest bone graft (ICBG); Intramedullary nailing; Mesenchymal stem cells; Reamer Irrigator Aspirator (RIA)

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