Anterior iliac crest bone graft harvesting using the corticocancellous reamer system

Objective: To evaluate the anterior iliac crest bone graft harvesting proce dure using a corticocancellous acetabular reamer system. Design: A total of 390 bone, grafting procedures were reviewed using retros pective chart review. Two hundred twenty procedures were performed using th e reamer system, and 170 were performed using traditional techniques (corti cal strip, tricortical wedge, and cancellous trap door grafts), Setting: The Hospital for Special Surgery, New York, New York. Participants: Operative cases involving an anterior iliac crest bone graft procedure between January 1, 1991 and February 28, 1998. Main Outcome Measurements: Complications were organized by the categories m ajor, intermediate, and minor. Statistical analysis included assessment of comorbidity to determine risk factors that may be associated with a propens ity for complications. Results: Of the 390 patients reviewed, 13.1 percent (51 of 390) developed a total of seventy-one complications. Of the seventy-one complications, fort y were reamer-associated and thirty-one were traditional method-associated complications. As compared with the traditional group, major morbidity was lower in the reamer group (0.9 percent [2 of 220] as compared with 1.8 perc ent [3 of 170] [p = 0.4]). Intermediate and minor morbidity were slightly h igher in the reamer group than in the traditional group (5.9 percent [13 of 220] as compared with 5.3 percent [9 of 170] [p = 0.7] and 9.5 percent [21 of 220] as compared with 7.1 percent [12 of 170] [p = 0.4], respectively). Of the forty reamer-associated complications, 90 percent (36 of 40) resolv ed within ninety days (average 36.6 days). Of the thirty-one traditional me thod-associated complications, 74.2 percent (23 of 31) were resolved by 90 days (average 50.6 days). Using logistical regression analysis obesity (bod y mass index) (p = 0.03) and smoking (p = 0.03) were correlated with develo pment of a complication. Furthermore, if a patient was obese and a smoker, the analysis predicted an 83 percent chance of developing a complication. Conclusions: The reamer technique was found to be safe and efficacious whil e producing a large amount of autogenous corticocancellous bone graft. Over all complication rates for the reamer and the traditional groups were compa rable. The corticocancellous reamer system represents an effective option f or bone graft harvesting.