Retrograde Reamer/Irrigator/Aspirator Technique for Autologous Bone Graft Harvesting With the Patient in the Prone Position

In recent years, the Reamer/Irrigator/Aspirator (RIA) system (Synthes, West Chester, Pennsylvania) has emerged as an extremely effective alternative in harvesting large volumes of autologous bone graft through reaming of the femoral intramedullary canal. The technique has been described in the literature as using an antegrade approach to the femur with the patient in the supine or prone position. It has also been described as a retrograde approach in the supine position.

In this article, we describe a new technique—a retrograde femoral approach with the patient in the prone position. This technique allows for more efficient preparation by eliminating the need to reposition, reprepare, and redrape the extremity, thus decreasing operative time and risk of infection. Although we present this technique for use in ankle and hindfoot arthrodesis, we think it can be valuable in any prone-position procedure, including spine surgery.