Abstract

Introduction: This study compared reamer-irrigator-aspirator (RIA) and standard reamer (SR) use in patients with metastatic bone disease (MBD) undergoing intramedullary nail (IMN) placement with regards to progression of MBD, complication rate, and overall survival. We hypothesize that RIA will reduce the rate of progression of MBD, reduce postoperative complications, and increase overall survival of patients with MBD.

Methods: One hundred forty-three patients (79 females, 64 males) with femur metastases were retrospectively analyzed after undergoing IMN placement with SR (122, 85.3%) or RIA (21, 17.2%) from 2009-2022. Patient demographics, oncologic and surgical history, complications, progressive disease, and survival were extracted from the medical record. Descriptive statistics including frequency counts and percentages for categorical variables as well as mean and standard deviation for continuous variables were used. Hypothesis testing with Fisher’s exact test for categorical variables and Student’s t-tests for continuous variables was performed. Finally, the Kaplan-Meier method was used to plot progression-free survival between RIA and SR groups.

Results: There were no statistically significant differences in length of operation, estimated blood loss, postoperative length of stay, complication rate, time to progression, time to death, or rates of postoperative cancer-specific mortality.

Conclusion: These findings failed to show a benefit to using RIA over SR; however, this study is limited by its small sample size and may be underpowered. Larger studies are needed to confirm these results.