RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

RIA 2

(Reamer Irrigator Aspirator)

Surgical Technique

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 1

TABLE OF CONTENTS

INTRODUCTION

SURGICAL TECHNIQUE

PRODUCT INFORMATION

RIA 2 (Reamer Irrigator Aspirator) 2

Indications 3

Preparation 4

Assembly 7

Reaming 10

Extracting Bone Graft 12

Disassembly 14

Instrument Set List 16

Procedure Kits 17

Reamer Heads 18

Additionally Available Items 19

2 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

RIA 2 (REAMER IRRIGATOR ASPIRATOR)

Introduction

The RIA 2 System is designed for reaming of the medullary canal for preparation of internal ﬁxation,

harvest of bone and bone marrow, and/or clearing of debris. The RIA 2 System consists of disposable

Reamer Heads, Tube Assembly, Reaming Rod Seal, Graft Filter, Irrigation and Aspiration Tubes, and

reusable Drive Shaft. Ports in the handle of the Tube Assembly allow both irrigation and aspiration

through the Tube Assembly during the reaming process. Irrigating ﬂuid is passed through the cannula

of the Drive Shaft and the Reamer heads. The aspiration ﬂuid is drawn through the Tube Assembly

and out through the Aspiration Tube. The disposables are offered in sterile procedural kits without

the Reamer Head. Assorted sizes of the Reamer Head are offered in individual sterile packs.

KEYED REAMING

ROD SEAL FOR SEAL

INTEGRITY

ACCEPTS MODIFIED

TRINKLE OR JACOBS

CHUCK COUPLING

CLOSED BOTTOM FILTRATION WITH 100 CC

CAPACITY AND INTEGRATED WIPER FOR

GRAFT EXTRACTION

ASPIRATION PORTS WITH

DOUBLE LEAD AUGER

FOR MATERIAL FLOW

BUILT-IN CLAMP ALLOWS

FOR FLOW CONTROL

IRRIGATION FLUID

BONE MARROW,

MORSELIZED BONE

QUICK CONNECT

ERGONOMIC HANDLE

WITH INTEGRATED DRIVE

SHAFT COUPLING

QUICK CONNECT

BUILT-IN CLAMP

EXCHANGEABLE REAMER HEADS

FROM 10 MM TO 18 MM IN

0.5 MM INCREMENTS

• SINGLE-USE COMPONENTS OFFERED IN STERILE PROCEDURE KITS.

REAMER HEADS ARE PACKAGED SEPARATELY.

The DePuy Synthes RIA 2 Tube Assembly, Reamer Heads, Reaming Rod Seal, Graft Filter,

and Irrigation and Aspiration Tubes are provided STERILE for single-use only. DO NOT RE-STERILIZE.

The Drive Shaft is offered NONSTERILE only.

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 3

Indications

The DePuy Synthes RIA 2 System is intended for use in adults and adolescents (12-21 years)

• To clear the medullary canal of the bone marrow and debris

• To effectively size the medullary canal for the acceptance of an intramedullary implant or prosthesis

• To harvest ﬁnely morselized autogenous bone and bone marrow for any surgical procedures requiring

bone graft to facilitate fusion and/or ﬁll bone defects

• To remove infected and necrotic bone and tissue from the medullary canal in the treatment

of osteomyelitis

4 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

1. SELECTION OF THE APPROPRIATE RIA 2 KIT

03.404.000S RIA 2 Bone Harvesting Kit, 520 mm, sterile

03.404.001S RIA 2 Reaming Kit, 520 mm, sterile

Select the appropriate RIA 2 kit based on procedure type.

For bone harvesting procedure, use the RIA 2 Bone Harvesting Kit, 03.404.000S

For reaming only procedure, use the RIA 2 Reaming Kit, 03.404.001S

2. REAMER HEAD SIZE SELECTION

Instrument

351.717 Depth Gauge (radiographic ruler)

03.010.023 Radiographic Canal Width Estimator for IM nails

To estimate the canal diameter, position the image intensiﬁer for an AP view of

the limb at the level of the isthmus. Hold the radiographic ruler perpendicular

to the limb and overlay the diameter tabs over the isthmus. Read the diameter

on the tab that ﬁlls the canal. Repeat with an ML view.

CAUTION:

The distance of the radiographic ruler from the bone and the position

of the C-arm receiver affect the image magniﬁcation and thus the

diameter measurement.

For bone harvesting, select a Reamer Head up to 1.5 mm larger than the canal

diameter at the isthmus.

When reaming to prepare the intramedullary canal for an implant, choose the

appropriate implant diameter ﬁrst. Select a Reamer Head based upon the nail

manufacturer’s recommendation.

PREPARATION

NOTE:

Always place the radiographic

ruler on the side of the limb

closest to the C-arm receiver.

Estimate the width as follows:

Distance between radiographic

ruler and bone

a. 25 mm = 1 mm larger reading

b. 50 mm = 2 mm larger reading

c. 100 mm = 3 mm larger reading

Measure in both AP and ML view.

Pre-operative images can also

be used for canal size reference.

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 5

3. OPEN CANAL

Instruments

357.399 3.2 mm Guide Wire, 400 mm

03.010.040 12.0 mm Cannulated Awl

357.399 3.2 mm Guide Wire, 400 mm

357.403 6.0 mm/10.0 mm Stepped Drill Bit - Cannulated/large QC/435 mm

03.010.030 13.0 mm Protection Sleeve

03.010.031 13.0 mm/3.2 mm Wire Guide with trocar tip

357.399 3.2 mm Guide Wire, 400 mm

03.010.036 12.0 mm Cannulated Drill Bit

357.127 13.0 mm Protection Sleeve

357.128 13.0 mm/3.2 mm Trocar Tip

Open the medullary canal and conduct reaming by following AO reaming

techniques for IM nailing and maintain a guide wire entry angle of less than

10° from the axis of the canal.

CAUTION:

If the guide wire entry angle is greater than 10° from the axis of the

canal, there is a risk that bowing of the reaming rod will result in:

• Eccentric reaming of the far cortex

•

Damage to the reamer head connection, resulting in metal

fragments in the canal.

NOTE:

For an antegrade femoral approach, if possible,

adduct the limb/hip to facilitate access to entry

point. For greater trochanter entry point,

target >2cm distal to the lesser trochanter.

For an antegrade tibial approach, the knee will

need to be ﬂexed to 90-110° for entry site access.

Insert the guide wire aiming down the tibial crest,

and thus the center of the medullary canal.

Preparation

10° Max

6 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

4. INSERT REAMING ROD (REAMING GUIDE WIRE)

Instruments

393.10 Universal Chuck with T-Handle

351.706S 2.5 mm Reaming Rod with ball tip, 950 mm, sterile

351.707S 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile

Attach the Universal Chuck with T-handle to the reaming rod. Reduce the fracture

(if present). Pass a 2.5 mm reaming rod into the canal and past the fracture site

to desired reaming depth. Verify its position with the image intensiﬁer.

Preparation

NOTE:

Ensure the reaming rod is centered

in the canal in both A-P and

Lateral views.

Proximal A-P View

Distal A-P View

Proximal Lateral View

Distal Lateral View

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 7

1. INSERT REAMING ROD SEAL

Instrument

03.404.035 Drive Shaft for RIA 2, 520 mm

Ensure the Reaming Rod Seal with the black circle faces the distal end and

insert it into the slot on the power driver end of Drive Shaft.

NOTE:

The Reaming Rod Seal is designed to be fully inserted into the slot

of the Drive Shaft.

2. INSERT DRIVE SHAFT INTO THE TUBE ASSEMBLY

Take the Tube Assembly and insert the Drive Shaft with seal into the back of

the Tube Assembly handle until it is fully seated.

Ensure the Drive Shaft is fully seated into the handle and cannot be pulled out.

3. ATTACH DRIVE UNIT TO THE END OF THE

DRIVE SHAFT

Instrument

03.404.035 Drive Shaft for RIA 2, 520 mm

Attach the assembled Tube Assembly with Drive Shaft to a Modiﬁed Trinkle

drill adapter.

Select a power drive unit that will deliver 3.5 Nm to 6.0 Nm of torque

and 700 rpm to 900 rpm (standard drill speed).

Ensure drill setting is selected for the power driver.

CAUTION:

Do not use drill with torque greater than 6 Nm. Do not use a reduction

drive. Do not use power driver designed for reaming.

Alternatively, a Jacobs chuck can be used to attach the Drive Shaft to the drive unit.

NOTE:

Do not turn the power on when the Drive Shaft is disengaged from

the Tube Assembly.

ASSEMBLY

8 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

Assembly

4. ATTACHING GRAFT FILTER FOR BONE HARVESTING

OR SPECIMEN COLLECTION (SKIP FOR REAM ONLY)

Check to ensure the lid of the Graft Filter is closed and secured.

Connect the female end of quick coupling on the Graft Filter to the male end

of the quick coupling attached to the aspiration port on the handle.

NOTE:

The aspiration port is the larger port with the quick connect coupling

and indicated with a letter “A”.

Connect the female end of the quick coupling on the suction tubing to the

male end of the quick coupling at the bottom of the Graft Filter.

5. CONNECT ASPIRATION TUBE

When using the RIA 2 System for reaming only, connect the Aspiration Tube

directly to the aspiration port on the Tube Assembly handle, bypassing the

instructions for connecting the Graft Filter in Step 4.

With or without the Graft Filter, connect the remaining end of the Aspiration

Tube to a single suction canister with vacuum source.

NOTE:

Connect the Aspiration Tube directly to the suction canister to avoid a

reduction in suction. Never connect several suction canisters in series.

Start the vacuum source.

NOTE:

Recommended operating vacuum pressure range is between

200 and 350 mmHg

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 9

Assembly

6. CONNECT IRRIGATION TUBE

Materials

• 1-2 liter container of irrigation ﬂuid (Not provided by DePuy Synthes)

• Irrigation Tube

Suspend a one (1) or two (2) liter container of irrigation ﬂuid approximately one

meter above the level of the patient.

Connect the end of the Irrigation Tube to the irrigation port on the tube

assembly handle.

NOTE:

The irrigation port is the smaller of the two ports and is indicated

by the letter “I”.

Ensure that one of the irrigation clamps is closed.

Attach spike end of tubing set to the irrigation container.

NOTE:

At least one of the clamps on the Irrigation Tube should be closed

until reaming begins.

7. ATTACH REAMER HEAD

Materials

03.404.016S - 03.404.032S

Reamer Heads for RIA 2,

10.0 mm - 18.0 mm, sterile

Using the protective sleeve, insert the selected Reamer Head (determined in

step 2) into the distal end of the drive shaft until it is fully seated.

NOTE:

The gear of the Reamer Head needs to be aligned with the spline in the

Drive Shaft to be fully seated.

CAUTION:

Reamer Heads are extremely sharp. Use the provided protective sleeve

to handle the Reamer Head.

10 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

REAMING

1. INTRODUCE RIA 2 SYSTEM INTO

MEDULLARY CANAL

Ensure the clamps on Irrigation and Aspiration Tubes are open.

Guide the Reamer Head over the 2.5 mm reaming rod and into the prepared

canal opening of the bone.

NOTE:

Prior to insertion into patient’s limb, ensure irrigate is ﬂowing and

suction is present at the aspiration holes at the tip of the assembly.

Advance the RIA 2 System, without power, over the reaming rod until the

Reamer Head is inserted into the entry point of the canal.

Check position on the image intensiﬁer.

NOTE:

Flow of aspiration begins when aspiration holes are fully immersed

in the bone.

CAUTION:

Never ream when there is no irrigation/aspiration. The irrigation/

aspiration ﬂuid cools the Reamer Head and removes bone marrow

and morselized bone from the medullary canal. Fluid ﬂow is

crucial for proper system performance.

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 11

3. TURN OFF IRRIGATION

AND ASPIRATION

When reaming is completed, retract the RIA 2 System

and turn off the irrigation and suction.

2. REAM

Minimize direct soft tissue contact with suction holes to prevent potential

clogging.

Using the power driver in drill setting, begin reaming under power, slowly

advancing the Reamer Head 20–30 mm and then retracting 50–80 mm,

allowing the irrigation ﬂuid to ﬂow in front of the Reamer Head. Advance the

RIA 2 System until resistance is felt, then repeat the advance and retraction

technique to continue reaming.

Use intermittent image intensiﬁcation to monitor the Reamer Head position

during reaming.

NOTE:

An insufﬁcient irrigation volume may lead to clogging. To prevent

clogging, avoid rapid advancement of the assembly.

CAUTION:

• Periodically check that the reaming aspirate is ﬂowing through the

tube and into the suction canister. If there is no material ﬂow, stop

reaming, turn off suction and retract the reamer head outside the

patient to evaluate for obstructions in the ﬂow path.

• Stop suction if the reaming is paused with reamer in the canal.

Extended reaming under suction may result in excessive blood loss.

Clamps on the suction tube can also be used to stop suction.

After the Reamer Head reaches the desired depth, withdraw the RIA 2 System

with power on until the Reamer Head is at the canal entry site.

Reaming

12 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

EXTRACTING BONE GRAFT

1. DISCONNECT THE GRAFT FILTER

Disconnect the Graft Filter by disconnecting the quick coupling

at the top of the ﬁlter.

2. OPEN GRAFT FILTER

Unscrew and open the lid of the Graft Filter.

NOTE:

If the suction has not been turned off or clamped, it may be difﬁcult

to remove the Graft Filter lid.

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 13

3. REMOVE FILTER ELEMENT (OPTIONAL)

Disconnect the Aspiration Tube and over a sterile container (bowl or basin),

press the blue tabs on the ﬁlter and pull the ﬁlter out of the canister.

Extracting Bone Graft

5. EXTRACT GRAFT MATERIAL (IF APPLICABLE)

Pull the white inner sleeve out slowly, extracting the graft material over

a sterile container.

4. REMOVE EXCESS FLUID (OPTIONAL)

Instrument

03.404.037 Graft Compressor for RIA 2 Graft Filter

Lift white inner sleeve out by 2 cm and seat the Graft Compressor into the ﬁlter.

With Graft Compressor held down, pull white inner sleeve to remove excess ﬂuid.

14 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

REAMER HEAD EXCHANGE

EXCHANGE REAMER HEAD

Instrument

03.404.038 Reamer Head Removal Tool for RIA 2

Remove RIA 2 System completely from the reaming rod. Place the Reamer Head

into the Removal Tool and pull the Reamer Head away from the Drive Shaft.

Insert the new Reamer Head as instructed in step 7 of the Assembly section.

CAUTION:

Reamer Heads are extremely sharp. Use the provided protective

sleeve to handle the Reamer Head.

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 15

DISASSEMBLY

Ensure that the reaming rod has been removed from the Drive Shaft.

Place the Reamer Head into the Removal Tool and pull the Reamer Head away

from the Drive Shaft.

CAUTION:

Reamer Heads are extremely sharp. Use the provided protective

sleeve to handle the Reamer Head.

Disconnect and dispose of the Irrigation/Aspiration tubes.

Remove the Drive Shaft from the Tube Assembly by pressing and holding the

blue tab at the end of the handle then pull the Drive Shaft out.

Remove and dispose of the Reaming Rod Seal from the Drive Shaft.

NOTE:

Dispose of the Tube Assembly, Reamer Head, and Reaming Rod Seal.

These are single-use items.

16 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

PRODUCT INFORMATION

RIA 2 INSTRUMENT SET – 01.404.000

PART NUMBER DESCRIPTION QUANTITY

03.404.035 Drive Shaft for RIA 2 - 520 mm 2

357.399 3.2 mm Guide Wire 400 mm 4

393.10 Universal Chuck with T-handle 1

351.717 Depth Gauge (radiographic ruler) 1

351.719 Depth Gauge Extension Tube 1

357.403

6.0 mm/10.0 mm Stepped Drill Bit -

Cannulated/large QC/435 mm

03.010.030 13.0 mm Protection Sleeve 1

03.010.031 13.0 mm/3.2 mm Wire Guide, with trocar tip 1

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 17

Product Information

PART NUMBER DESCRIPTION QUANTITY

357.127 13.0 mm Protection Sleeve 1

03.010.036 12.0 mm Cannulated Drill Bit, Large QC/190 mm 1

357.128 13.0 mm/3.2 mm Trocar Tip 1

03.010.040 12.0 mm Cannulated Awl 1

03.404.037 Graft Compressor for RIA 2 Graft Filter 1

03.404.038 Reamer Head Removal Tool for RIA 2 1

60.404.000 Graphic Case with Lid for RIA 2 Instrument Set 1

PROCEDURE KITS:

PART NUMBER DESCRIPTION

03.404.000S RIA 2 Bone Harvesting Kit, 520 mm, Sterile

03.404.001S RIA 2 Reaming Kit, 520 mm, Sterile

18 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

Product Information

REAMER HEADS:

PART NUMBER DESCRIPTION

03.404.016S 10.0 mm Reamer Head for RIA 2, Sterile

03.404.017S 10.5 mm Reamer Head for RIA 2, Sterile

03.404.018S 11.0 mm Reamer Head for RIA 2, Sterile

03.404.019S 11.5 mm Reamer Head for RIA 2, Sterile

03.404.020S 12.0 mm Reamer Head for RIA 2, Sterile

03.404.021S 12.5 mm Reamer Head for RIA 2, Sterile

03.404.022S 13.0 mm Reamer Head for RIA 2, Sterile

03.404.023S 13.5 mm Reamer Head for RIA 2, Sterile

03.404.024S 14.0 mm Reamer Head for RIA 2, Sterile

03.404.025S 14.5 mm Reamer Head for RIA 2, Sterile

03.404.026S 15.0 mm Reamer Head for RIA 2, Sterile

03.404.027S 15.5 mm Reamer Head for RIA 2, Sterile

03.404.028S 16.0 mm Reamer Head for RIA 2, Sterile

03.404.029S 16.5 mm Reamer Head for RIA 2, Sterile

03.404.030S 17.0 mm Reamer Head for RIA 2, Sterile

03.404.031S 17.5 mm Reamer Head for RIA 2, Sterile

03.404.032S 18.0 mm Reamer Head for RIA 2, Sterile

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 19

ADDITIONALLY AVAILABLE ITEMS:

PART NUMBER DESCRIPTION

530.793 Modiﬁed Trinkle Drilling Attachment for Battery Power Line

03.010.023 Radiographic Canal Width Estimator for IM nails

338.10 8.0 mm Drill Bit for DHS/DCS Triple Reamer

351.05 Tissue Protector

351.706S 2.5 mm Reaming Rod with ball tip, 950 mm, sterile

351.708S 2.5 mm Reaming Rod with ball tip, 1150 mm, sterile

351.707S 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile

Product Information

Note: For additional information, please refer to the package insert or

www.e-ifu.com.

For detailed cleaning and sterilization instructions, please refer to

www.depuysynthes.com/hcp/cleaning-sterilization or sterilization

instructions, if provided in the instructions for use.

20 DePuy Synthes RIA 2 (Reamer Irrigator Aspirator) Surgical Technique

1. Paulo Barbosa and Clifford Turen. (2012). AO teaching video: Femur—Shaft fracture 32-B2 Intramedullary nailing with the Expert

Lateral Femoral Nail (LFN). Retrieved from

https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/femoral-shaft/simple-oblique-middle-1-3-fractures/

antegrade-nailing#antegrade-nailing-approaches

2. Matthias Hansen, Dankward Höntzsch. (2006). AO teaching video: Tibia Fractures - Intramedullary Nailing with the Expert Tibial Nail

(with reaming). Retrieved from

https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/tibial-shaft/simple-fracture-transverse/intramedullary-

nailing#patient-preparation-and-approach

REFERENCES

RIA 2 (Reamer Irrigator Aspirator) Surgical Technique DePuy Synthes 21

www.depuysynthes.com

Synthes USA Products, LLC

1302 Wrights Lane East

West Chester, PA 19380

To order (USA): 800 523-0322

To order (Canada): 844-243-4321

Synthes USA, LLC

1101 Synthes Avenue

Monument, CO 80132

Please refer to the package insert for a complete list of indications, contraindications, precautions and warnings.

For further information on DePuy Synthes Companies products, please contact your local DePuy Synthes representative.

The third party trademarks used herein are the trademarks of their respective owners.

Some devices listed in this technique guide may not have been licensed in accordance with Canadian law and may not

be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

Synthes GmbH

Luzernstrasse 21

4528 Zuchwil, Switzerland

Note: For recognized manufacturer, refer to the product label.