Bone Graft Harvesting Techniques and Donor Site Morbidity

Autologous bone grafting remains the clinical gold standard for the restoration of skeletal defects, leveraging the patient’s own bone to promote osteogenesis, osteoinduction and osteoconduction. Traditional donor sites include the iliac crest and long-bone intramedullary canals, each associated with distinct profiles of graft availability and postoperative discomfort. The iliac crest delivers both cortical and cancellous bone but can result in chronic pain, sensory disturbance and gait impairment. Advances in intramedullary harvesting, notably the reamer–irrigator–aspirator (RIA) technique, have offered minimally invasive access to cancellous bone slurry, reducing donor site complications such as herniation and structural weakening. Recent innovations aim to preserve growth factors and progenitor cells by refining irrigation protocols or developing stepwise aspiration and reaming methods. Attention to donor site morbidity has driven optimisation of graft volume, surgical approach and patient selection, with emerging evidence supporting reduced long-term pain, faster mobilisation and lower rates of infection and hematoma formation. The interplay between graft quality, cellular content and patient outcome underscores a global imperative to balance regenerative potential against procedural risk, thereby informing both surgical practice and biomaterial development.

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Bone Graft Harvesting Techniques and Donor Site Morbidity publication trend

The graph below shows the total number of articles in bone graft harvesting techniques and donor site morbidity across all publications each year (not limited to Nature Index journals).

Technical terms

Autologous bone grafting: Transplantation of bone tissue harvested from the same individual to promote skeletal repair.

Reamer–Irrigator–Aspirator (RIA) system: A surgical device that simultaneously reams the intramedullary canal while irrigating and aspirating loosened bone and marrow.

Iliac Crest Bone Graft (ICBG): Harvesting of cortical and cancellous bone from the pelvic iliac crest for grafting purposes.

Osteoinduction: The process by which growth factors within graft material stimulate progenitor cells to differentiate into osteoblasts.

Donor site morbidity: The spectrum of complications—pain, sensory changes, structural compromise—arising from the graft harvest location.

References

1. A case report of membrane induction combined with RIA technique for the repair of distal humerus segmentary bone defect. Frontiers in Endocrinology (2023).
2. It is not waste if it is therapy: cellular, secretory and functional properties of reamer–irrigator–aspirator (RIA)-derived autologous bone grafts. Journal of Orthopaedics and Traumatology (2025).
3. An in vivo study to investigate an original intramedullary bone graft harvesting technology. European Journal of Medical Research (2023).
4. Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review. Journal of Clinical Medicine (2021).
5. Prospective evaluation of chronic pain associated with posterior autologous iliac crest bone graft harvest and its effect on postoperative outcome. Health and Quality of Life Outcomes (2009).
6. Complications and risk management in the use of the reaming-irrigator-aspirator (RIA) system: RIA is a safe and reliable method in harvesting autologous bone graft. PLOS ONE (2018).