Does Use of Demineralized Bone Matrix Affect the Union Rate in Arthroscopic Ankle Fusions?

Category: Ankle Introduction/Purpose: Despite DBM having positive effects on union rates in other subspecialties of orthopaedics, there is a general lack of evidence about bone graft substitutes in foot and ankle surgery. To our knowledge, orthopaedic surgeons have never evaluated the use of demineralized bone matrix (DBM) as it pertains to the union rate of arthroscopic ankle fusions. The purpose of this clinical study is to compare the rate of union in arthroscopic ankle fusions in patients that have had DBM to those without DBM. The hypothesis of this study was that use of DBM would increase the union rate in all patients undergoing arthroscopic ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. Seventy-one ankles from 68 patients met inclusion criteria. These patients underwent primary arthroscopic ankle arthrodesis. Forty patients had DBM and 31 patients did not have DBM. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of arthroscopic ankle arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Seventy-one patients were available for final follow-up. Average age of the patients was 55.3 +/- 17.6 years. The mean follow-up time was 39.5 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. Nonunion rate of patients who did have DBM was 7/40 (18%) and nonunion rate of those who did not have DMB was 8/31 (26%) (p=0.40). There was no statistically significant difference between those who did have DBM and those who did not have DBM in wound complication rate (5% vs 6%, p=1.0), rate of return to the operating room (35% vs 39%; p=0.75), and DVT rate (0% vs 0%), respectively. There were no major complications in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had DBM versus those who did not in the setting of arthroscopic ankle fusion. In this study, use of DBM does not affect union rate in patients undergoing arthroscopic ankle arthrodesis. Additionally, use of DBM does not affect the rate of wound complications, return to the operating room, and development of post-operative DVT.

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Comparison of Non-Union and Complication Rates in Primary versus Revision Tibiotalar Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00091 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Operating Room ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Wound Complications ◽

Complication Rates ◽

Ankle Arthritis ◽

Union Rate ◽

Tibiotalar Arthrodesis ◽

Complications Rate

Category: Ankle Arthritis Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. Patients with a nonunion often undergo revision ankle arthrodesis, as it is the most common salvage procedure in this situation. To date, only a few studies have evaluated outcomes in patients with revision ankle arthrodesis. The purpose of this clinical study is to directly compare the rate of union and complications in primary versus revision tibiotalar arthrodesis. The hypothesis of this study was that there would be no difference in rate of union and complications between primary and revision ankle arthrodesis. Methods: This is a retrospective review of 455 consecutive patients that underwent either primary or revision tibiotalar arthrodesis between March 2002 to November 2014. Three-hundred eighty-five patients underwent primary arthrodesis and 70 patients underwent revision arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Average age of the patients was 56 +/- 15 years (range 18-89). The mean follow-up time was 38.3 +/- 27.4 months (range 12-150.4 months). All patients had a minimum follow-up of 12 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. The nonunion rate of patients who had primary arthrodesis was 37/385 (9.6%) and revision arthrodesis was 6/70 (8.5%) (p=0.74) (Table 1). Additionally, there was not a significant difference between those who had primary versus revision ankle arthrodesis surgery in rate of wound complication, return to the operating room, and post-operative DVT (Table 2). There were no major complications in this study. Conclusion: This is the largest study to directly compare union rates and complication rates in patients who underwent primary versus revision ankle arthrodesis. In this study, primary versus revision tibiotalar arthrodesis does not affect union rate, time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative DVT.

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Complications Following Arthroscopic Ankle Arthrodesis

Foot & Ankle International ◽

10.1177/107110079601700608 ◽

1996 ◽

Vol 17 (6) ◽

pp. 340-342 ◽

Cited By ~ 75

Author(s):

Lynn A. Crosby ◽

Ted C. Yee ◽

Teri S. Formanek ◽

Timothy C. Fitzgibbons

Keyword(s):

Bone Marrow ◽

Complication Rate ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Fusion Rate ◽

Ankle Arthrodesis ◽

Deep Infection ◽

Pin Site ◽

Demineralized Bone

Forty-two patients underwent an arthroscopic ankle arthrodesis utilizing a bi-framed distraction technique and demineralized bone matrix-bone marrow slurry as a graft substitute. The average follow-up was 27 months (range, 12–64 months). The overall complication rate was 55%, including three nonunions (7%), two fractures (4.8%), four pin site infections (9.5%), one deep infection, four hardware problems (9.5%), and four symptomatic painful subtalar joints (9.5%). Overall, 85% of patients were satisfied with their final result. The complication rate was high but most complications were minor and manageable. The demineralized bone matrix and bone marrow did not seem to increase the fusion rate over what has been documented previously for arthroscopic ankle fusions without the use of this graft substitute.

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Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211025197 ◽

2021 ◽

pp. 105566562110251

Author(s):

Vijay Kumar ◽

Vidya Rattan ◽

Sachin Rai ◽

Satinder Pal Singh ◽

Jai Kumar Mahajan

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Volumetric Analysis ◽

Group I ◽

Alveolar Bone Grafting ◽

Group Ii ◽

Demineralized Bone

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

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Demineralized Bone Matrix for Alveolar Cleft Management

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1375173 ◽

2014 ◽

Vol 7 (4) ◽

pp. 251-257 ◽

Cited By ~ 3

Author(s):

Jose Rolando Prada Madrid ◽

Viviana Gomez ◽

Bibiana Mendoza

Keyword(s):

Bone Formation ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Case Series ◽

Alveolar Cleft ◽

Case Series Study ◽

Demineralized Bone

The aim of this article is to describe the results of the use of demineralized bone matrix putty in alveolar cleft of patients with cleft lip and palate. We performed a prospective, descriptive case series study, in which we evaluated the results of the management of alveolar clefts with demineralized bone matrix. Surgery was performed in 10 patients aged between 7 and 26 years (mean 13 years), involving a total of 13 clefts in the 10 patients. A preoperative cone beam computed tomography (CBCT) was taken to the patients in whom the width of the cleft was measured from each edge of the cleft reporting values between 5.76 and 16.93 mm (average, 11.18 mm). The densities of the clefts were measured with a CBCT, 6 months postoperative to assess bone formation. The results showed a register of gray values of 1,148 to 1,396 (mean, 1,270). The follow-up was conducted for 15 to 33 months (mean, 28.2 months). The results did not show satisfactory bone formation in the cleft of patients with the use of demineralized bone matrix.

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Remineralization of demineralized bone matrix in critical size cranial defects in rats: A 6-month follow-up study

Journal of Biomedical Materials Research Part B Applied Biomaterials ◽

10.1002/jbm.b.33446 ◽

2015 ◽

Vol 104 (7) ◽

pp. 1336-1342 ◽

Cited By ~ 8

Author(s):

Dénes B. Horváthy ◽

Gabriella Vácz ◽

Ildikó Toró ◽

Tamás Szabó ◽

Zoltán May ◽

...

Keyword(s):

Critical Size ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Follow Up Study ◽

Demineralized Bone

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Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up

European Spine Journal ◽

10.1007/s00586-008-0869-5 ◽

2009 ◽

Vol 18 (2) ◽

pp. 238-243 ◽

Cited By ~ 43

Author(s):

Kıvanç Topuz ◽

Ahmet Çolak ◽

Serdar Kaya ◽

Hakan Şimşek ◽

Murat Kutlay ◽

...

Keyword(s):

Demineralized Bone Matrix ◽

Bone Matrix ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Demineralized Bone

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Use of Demineralized Bone Matrix in Ankle/Hindfoot Fusion

Foot & Ankle International ◽

10.1177/107110070302400706 ◽

2003 ◽

Vol 24 (7) ◽

pp. 557-560 ◽

Cited By ~ 47

Author(s):

David B. Thordarson ◽

Sarah Kuehn

Keyword(s):

Demineralized Bone Matrix ◽

Bone Matrix ◽

Matrix Product ◽

Union Rate ◽

Fusion Site ◽

Bone Graft Substitutes ◽

Hindfoot Fusion ◽

Historical Controls ◽

Cancellous Allograft ◽

Demineralized Bone

Sixty-three patients who underwent complex ankle or hindfoot fusion had demineralized bone matrix placed in their fusion site to stimulate fusion. Thirty-seven patients had Grafton putty, a demineralized bone matrix product, and 26 patients had Orthoblast, a demineralized bone matrix mixed with crushed cancellous allograft bone placed to stimulate their fusion site. All patients were followed clinically and radiographically to fusion or nonunion. Of the 37 patients who had Grafton putty placed to stimulate ankle or hindfoot fusion, five (14%) developed a nonunion. Of the 26 patients who had Orthoblast placed to stimulate fusion, two (8%) developed a nonunion. These differences were not statistically significant. Nonunion rates of approximately 10% continue to be reported for ankle and hindfoot fusion procedures. In an attempt to minimize this complication, various bone graft substitutes have been used. We found no difference in efficacy of the two demineralized bone matrix compounds, and were not able to demonstrate a superior union rate compared to historical controls.

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Does Open versus Arthroscopic Surgical Technique Affect the Union Rate of Tibiotalar Arthrodesis?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00092 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Surgical Technique ◽

Arthroscopic Surgery ◽

Wound Complication ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Union Rate ◽

Significant Difference ◽

Tibiotalar Arthrodesis ◽

Open Versus

Category: Arthroscopy Introduction/Purpose: To date, there are only a handful of studies directly comparing outcomes of open versus arthroscopic ankle arthrodesis. Major limitations of these studies are small patient cohorts, lack of long-term follow-up, lack of assessment pre-operative patient demographics and imaging, and post-operatively evaluation of clinical outcomes but not union rates. The purpose of this clinical study is to compare the rate of union in ankle fusions in patients that underwent open arthrodesis to those that underwent arthroscopic arthrodesis. The hypothesis of this study was that there would be no difference in union rate in patients that underwent open versus arthroscopic arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. One hundred twenty-five ankles from 121 patients met inclusion criteria. These patients underwent primary tibiotalar arthrodesis without the use of autograft. Fifty-nine patients underwent open tibiotalar arthrodesis and 66 patients underwent arthroscopic tibiotalar arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: One hundred twenty-one patients (125 ankles) were available for final follow-up. Average age of the patients was 55.3 +/- 17.2 years. Mean follow-up time was 35.4 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had open surgery was 10/59 (17%) and nonunion rate of those who had arthroscopic surgery was 13/66 (20%) (p=0.69) [Table 1]. There was a statistically significant difference between those who had open versus arthroscopic surgery in wound complication rate (39% vs 6%, p=<0.001) and DVT rate (7% vs 0%, p=0.047). There was no statistically significant difference in rate of return to the operating room. No major complications occurred in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had open versus arthroscopic ankle arthrodesis. In this study, no significant association was found between surgical technique and union rate in patients undergoing ankle arthrodesis. Additionally, use of the arthroscopic technique has significantly lower rates of wound complication and post-operative DVTs.

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