The Role of Allograft Bone in Foot and Ankle Arthrodesis and High-Risk Fracture Management

2018 ◽  
Vol 12 (5) ◽  
pp. 418-425 ◽  
Author(s):  
Shane Hollawell ◽  
Brendan Kane ◽  
Christopher Heisey ◽  
Patricia Greenberg
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Bone Graft ◽  
Ankle Arthrodesis ◽  
Delayed Union ◽  
Allograft Bone ◽  
Foot And Ankle ◽  
Angiogenic Growth Factors ◽  
Fracture Management ◽  
Fracture Types

Allogenic bone graft has long been accepted as a standard of care in the surgical arthrodesis of the foot and ankle and treatment of certain high-risk, comminuted fracture types that have greater potential for delayed union or nonunion. It has been shown in multiple studies to be equivalent to autograft in regard to union rates without the morbidity associated with bone graft harvest. We present a retrospective study on the efficacy of an allogenic cancellous/periosteal cellular bone matrix with mesenchymal stem cells and angiogenic growth factors. The study includes a cohort of 41 procedures and 40 patients who underwent foot and ankle arthrodesis, fracture fixation, or a simultaneous combination of both. Radiographic consolidation of the fracture/fusion site was reviewed at regular intervals (first postoperative visit at 1 week and 4, 8, and 12 weeks and at regular intervals until healing was confirmed). Age, workmen’s compensation insurance, diabetes, and nicotine use were evaluated as potential risk factors. Our retrospective study indicated that allograft bone has the potential to positively affect union rates in foot and ankle arthrodesis and certain high-risk fracture types that have potential for delayed union/nonunion. Levels of Evidence: Level IV

Trochanteric Bone Grafts in Foot and Ankle Surgery

1996 ◽  
Vol 17 (7) ◽  
pp. 402-405 ◽  
Author(s):  
W. Richard Hayes ◽  
Ronald W. Smith
Keyword(s):  
Bone Graft ◽  
Delayed Union ◽  
Iliac Bone ◽  
Patient Questionnaire ◽  
Foot And Ankle ◽  
Greater Trochanter ◽  
Graft Harvest ◽  
Iliac Bone Graft ◽  
Ankle Surgery

Eighty-five patients who underwent trochanteric bone graft harvest in association with foot and ankle surgery were studied retrospectively by patient questionnaire. The average follow-up was 49 months (range, 14–101 months). Ninety-five percent of the patients expressed satisfaction with the procedure, in that they would choose to accept the trochanteric bone graft again if required to make the choice. However, 31 % of the patients acknowledged some degree of hip discomfort and 4% reported some daily pain. Nineteen of 85 patients (22%) were treated for trochanteric pain. Most patients responded to strengthening/stretching and heat/ice. Four patients (5%) had failed or delayed union of the arthrodesis in which trochanteric bone graft was utilized. The greater trochanter may be considered as an alternative for major bone graft when the iliac bone is not available and when weightbearing is restricted for at least 6 weeks after surgery. As with the use of iliac bone graft, patients should be alerted to the possibility of postoperative discomfort. Surgical details should be followed to minimize the risk of peritrochanteric fracture.

Efficacy of a Cellular Allogeneic Bone Graft in Foot and Ankle Arthrodesis Procedures

2016 ◽  
Vol 21 (4) ◽  
pp. 855-861 ◽  
Author(s):  
Travis J. Dekker ◽  
Peter White ◽  
Samuel B. Adams
Keyword(s):  
Bone Graft ◽  
Ankle Arthrodesis ◽  
Allogeneic Bone ◽  
Foot And Ankle

Bone Graft Harvest from the Proximal Tibia in Foot and Ankle Arthrodesis Surgery

2006 ◽  
Vol 27 (11) ◽  
pp. 913-916 ◽  
Author(s):  
Michael R. Whitehouse ◽  
Ben J.A. Lankester ◽  
Ian G. Winson ◽  
Stephen Hepple
Keyword(s):  
Bone Graft ◽  
Proximal Tibia ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Graft Harvest

Efficacy of a Cellular Bone Allograft for Foot and Ankle Arthrodesis and Revision Nonunion Procedures

2016 ◽  
Vol 38 (3) ◽  
pp. 277-282 ◽  
Author(s):  
Travis J. Dekker ◽  
Peter White ◽  
Samuel B. Adams
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Bone Allograft ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Union Rate ◽  
Joint Preparation ◽  
History Of ◽  
Cellular Bone ◽  
Cellular Bone Allograft

Background: Bone graft substitutes are often required in patients at risk for nonunion, and therefore, an allograft that most closely mimics an autograft is highly sought after. This study explored the utility and efficacy of a cellular bone allograft used for foot and ankle arthrodesis and revision nonunion procedures in a patient population at risk for nonunion. Methods: An institutional review board–approved retrospective review of consecutive patients who underwent arthrodesis and revision nonunion procedures with a cellular bone allograft was performed at a single academic institution. No external sources of funding were provided for this study. Inclusion criteria included patients who were more than 1 year after surgery or less than 1 year after surgery if they had undergone a second operative procedure for nonunion or if they had computed tomography–documented union. Forty operative procedures in 36 patients with a mean follow-up of 13 months (range, 6-25 months) were included for data analysis. All patients had at least one of the following risk factors associated with nonunion: current smoker, diabetes, avascular necrosis (AVN) of the involved bone, active same-site operative infection, history of nonunion, previous same-site surgery, or gap of 5 mm or greater after joint preparation. The primary outcome was radiographic union. Results: The union rate in this high-risk population was 83% (33/40). Univariate analysis demonstrated that the use of a cellular bone allograft helped mitigate the presence of risk factors known to cause nonunion. There was no significant difference in fusion rates among groups with current smoking, AVN of the involved bone, active same-site operative infections, history of nonunion, rheumatoid arthritis on medication, previous same-site operative procedures or infections, or a gap of 5 mm or greater after joint preparation. However, in this population, diabetic and female patients remained at a high risk of recurrent nonunion ( P = .0015), despite the use of a cellular bone allograft. Chi-square analysis of patients with increasing numbers of risk factors directly correlated with an increased risk of nonunion ( P = .025). Four wound complications were reported in this cohort that required irrigation and debridement (10%). Conclusion: These data demonstrated a union rate of 83% in patients with risk factors known to cause nonunion. The benefits of the use of a cellular bone allograft allowed for the avoidance of morbidity associated with autograft harvesting while still improving the local biology to facilitate fusion in a difficult patient population to attain a successful fusion mass. Level of Evidence: Level IV, retrospective case series.

scholarly journals The Impact of Age and Graft Type on Foot and Ankle Arthrodesis Fusion Success

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0012
Author(s):  
Gregory C. Berlet ◽  
Judith F. Baumhauer ◽  
Mark A. Glazebrook ◽  
Alastair S. Younger ◽  
David Fitch ◽  
...  
Keyword(s):  
Bone Graft ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Ankle Arthrodesis ◽  
Osteogenic Potential ◽  
Foot And Ankle ◽  
Patient Age ◽  
Patient Âgé ◽  
Significant Difference ◽  
The Impact

Category: Ankle; Ankle Arthritis; Basic Sciences/Biologics; Hindfoot Introduction/Purpose: A recent survey of 100 international foot and ankle orthopaedic surgeons revealed that patient age greater than 60 years is not considered to be a significant risk factor for nonunion following foot and ankle arthrodesis. This finding was surprising as published basic science research shows that autologous bone graft used during fusion surgery may be less effective when harvested from older patients due to both diminished osteogenic potential and migration capacity of mesenchymal stem cells. The purpose of this study was to evaluate the impact of patient age and graft type on fusion rates following hindfoot and ankle arthrodesis. Methods: A Level 1 clinical trial was performed comparing fusion success in 397 hindfoot or ankle arthrodesis subjects (597 joints) supplemented with either autograft or an osteoinductive recombinant human protein derived growth factor (rhPDGF- BB/β-TCP) bone graft substitute. Fusion status was determined using computed tomography, with fusion defined as evidence of at least 50% osseous bridging. In this secondary analysis of that dataset, the odds of fusion success were compared for joints in autograft subjects older or younger than the following age thresholds: 55, 60, 65, 70 and 75 years. This analysis was then repeated for joints in rhPDGF-BB/β-TCP subjects. Finally, odds of fusion success were also compared for the autograft and rhPDGF-BB/β- TCP groups for subjects older than each threshold age. Results: Joints in autograft subjects younger than 60 and 65 years exhibited over two times the odds of fusion as those in older subjects (60 years: OR 2.24, p=0.003; 65 years: OR 2.74, p<0.001). There was no significant difference for other intervals (55 years: OR 1.45, p=0.106; 70 years: 1.64, p=0.096; 75 years: OR 1.28, p=0.335). Interestingly, there was no significant difference for the rhPDGF-BB/β-TCP group at any threshold (55 years: OR 0.86, p=747; 60 years: OR 0.86, p=0.739; 65 years: 1.08, p=0.367; 70 years: 0.94, p=0.588; 75 years: OR 0.70, p=0.809). When odds of fusion were compared for the two groups in subjects older than each age threshold, rhPDGF-BB/β-TCP had approximately two times the odds of fusion success for all except 55 years (Figure 1). Conclusion: This study indicates that age is an identifiable and potentially concerning risk for nonunion following hindfoot or ankle arthrodesis. These findings are in contrast to the wider perception of the surgeon community, as documented in the published survey. Notably, patients over the age of 60 years who are supplemented with autograft have statistically lower odds of fusion compared to those younger, a difference not seen with the use of recombinant technology. This analysis suggests that use of rhPDGF-BB/β-TCP as an alternative bone healing adjunct may help mitigate the risk of nonunion when these procedures are performed in the elderly population.

scholarly journals Retrospective Radiographic Evaluation of AugmentTM Bone Graft Fusion

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Trevor J. Shelton ◽  
Alvin K. Sheih ◽  
Eric Chang ◽  
Amy E. Steele ◽  
Eric Giza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Bone Graft ◽  
Ankle Arthrodesis ◽  
Smoking History ◽  
Categorical Variables ◽  
Foot And Ankle ◽  
Surgery Patient ◽  
Number Of Patients

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Augment is the first Food and Drug Administration approved synthetic bone substitute specifically formulated for foot and ankle procedures and have shown results comparable to autograft. Initial studies on the use of Augment for fusion procedures of the foot and ankle are encouraging but there remains a lack of radiographic outcomes on its use. The purposes of this study were to report on the radiographic fusion rate of Augment and identify risk factors for nonunion in patients treated with Augment. Methods: After institutional review board approval, a retrospective study was performed of all patients ages 18-85 who underwent arthrodesis of the ankle, hindfoot, or midfoot and used Augment alone or in combination with autograft and/or allograft. Patients were excluded if they did not have regular radiographic follow-up. Each operative report was examined for procedure performed and location of the foot involved. Post-operative radiographs were reviewed to look at union rate following surgery. Patient charts were reviewed for age, gender, Body Mass Index (BMI), smoking history, and diabetes to examine potential risk factors for nonunion. Continuous variables were reported in means ± standard deviations and differences determined between those that fused and those that did not using a Wilcoxon Rank Sums test. Categorical variables reported as number of patients (percent of patients) and differences determined between those that fused and those that did not using a Fisher’s exact test. Results: A total of 71 patients (average age at injury 57±14 years; 35 males (49%), 36 females (50%); BMI 31±6) underwent 33 (46%) midfoot arthrodesis, 41 (58%) hindfoot arthrodesis, and 27 (38%) ankle arthrodesis. A total of 58 patients (82%) went on to achieve fusion while 13 (18%) did not. There was no difference in gender (p=0.135), age (p=0.345) or BMI (p=0.196) between those who achieved fusion and those who did not. Patients with diabetes had a greater risk of nonunion compared to those who did not (p=0.033) while current smoking status or revision fusion did not pose a risk factor (p=1.000) (Table 1). There were no differences in part of the foot/ankle involved (p=0.445) or bone graft used (p=0.303). Conclusion: This the first study to examine the radiographic follow up of union using Augment. The most important finding of this study is that the rate of fusion in foot and ankle arthrodesis using Augment is near 82%. Diabetes is a risk factor for nonunion when using Augment. Smoking, gender, age, BMI, autograft vs allograft, and part of the foot or ankle fused did not pose a risk factor.

The Slot Graft Technique for Foot and Ankle Arthrodesis in a High-Risk Patient Group

2011 ◽  
Vol 32 (7) ◽  
pp. 686-692 ◽  
Author(s):  
Sandra E. Klein ◽  
Ryan M. Putnam ◽  
Jeremy J. McCormick ◽  
Jeffrey E. Johnson
Keyword(s):  
High Risk ◽  
Patient Group ◽  
High Risk Patient ◽  
Ankle Arthrodesis ◽  
Risk Patient ◽  
Foot And Ankle

scholarly journals PO 18164 - Subtalar arthrodesis with bone graft

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. S34
Author(s):  
Henrique Mansur ◽  
Gil Galvão Bernardes Silveira ◽  
Isnar Moreira De Castro Junior
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Union Rate ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Different Types ◽  
Bone Autograft

Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.

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