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

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).

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.

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).

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.