Comparison of donor-site morbidity and functional outcomes between lateral iliac crest-preserving iliac bone harvesting and conventional iliac bone harvesting: a retrospective case-control study.

BACKGROUND

The iliac crest is the most frequently used donor site for harvesting autologous corticocancellous bone grafts. However, the reported incidence of donor-site morbidity after autologous corticocancellous iliac crest bone graft harvesting varies widely, potentially owing to differences in harvesting techniques. This study describes a lateral iliac crest-preserving iliac crest bone graft harvesting (LICP-ICBG) technique for obtaining autologous corticocancellous bone grafts and compares donor-site complications and functional outcomes with those of conventional corticocancellous iliac crest bone graft harvesting (CLCH).

METHODS

In this study, 101 patients were included and classified according to the harvesting technique: LICP-ICBG (n = 50) and CLCH (n = 51). Intraoperative blood loss and donor-site complications were recorded. Postoperative pain was assessed using a visual analog scale (VAS) on postoperative days 1, 3, and 7. Functional impairment was evaluated using a questionnaire focusing on gait, stair climbing, and difficulty rising from a seated position. Donor-site healing was assessed on pelvic radiographs.

RESULTS

Intraoperative blood loss was lower in the LICP-ICBG group than in the CLCH group. Donor-site complications occurred in 10% (5/50) of patients in the LICP-ICBG group, including incisional hematoma/seroma in 4% (2/50), donor-site infection in 4% (2/50), and residual pain in 2% (1/50). In the CLCH group, complications occurred in 25.5% (13/51), including incisional hematoma/seroma in 9.8% (5/51), donor-site infection in 3.92% (2/51), nerve injury in 3.92% (2/51), residual pain in 3.92% (2/51), and iliac crest contour depression in 3.92% (2/51), with a significant between-group difference (p < 0.05). VAS pain scores on postoperative days 1, 3, and 7 and patient-reported satisfaction regarding gait, stair climbing, and hip function during daily activities did not differ significantly between groups (all p > 0.05). For rising from a seated position, 2% (1/50) of patients in the LICP-ICBG group were somewhat dissatisfied, whereas in the CLCH group 11.8% (6/51) were somewhat dissatisfied and 3.9% (2/51) were very dissatisfied (p = 0.02).

CONCLUSIONS

Compared with CLCH, the LICP-ICBG technique was associated with lower intraoperative blood loss and a lower rate of donor-site complications, particularly fewer nerve injuries and iliac crest contour depressions. Although postoperative pain and most functional outcomes were comparable, patients reported better performance when rising from a seated position. Radiographic follow-up suggested improved preservation of iliac wing contour and more favorable donor-site healing. This modified technique may help reduce donor-site morbidity and preserve the iliac crest contour while providing sufficient autologous corticocancellous bone graft material.