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.

scholarly journals Subtalar arthrodesis with bone graft. Is it needed for smokers?

2019 ◽  
Vol 13 (1) ◽  
pp. 49-54
Author(s):  
Gil Galvão Bernardes Silveira ◽  
Isnar Moreira Castro Junior ◽  
Henrique Mansur ◽  
Guilherme Ferreira Morgado
Keyword(s):  
Retrospective Study ◽  
Bone Graft ◽  
Donor Site ◽  
P Value ◽  
Union Rate ◽  
Chi Square ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Chi Square Test ◽  
Autologous Bone

Objective: To evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and effect of the use of different types of autologous bone grafts. Methods: This was a retrospective study with radiological evaluation of patients with subtalar arthrosis who underwent primary arthrodesis at a reference hospital between January 2008 and December 2014. Patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years (range: 19-74 years) were evaluated, among whom 90 (40%) were smokers and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was due to sequelae of calcaneal fractures. A bone graft was used in 65 (27.7%) patients. The overall union rate was 85.4%, and 14.6% of the patients progressed to pseudoarthrosis. A statistically significant difference was found in the nonunion rate in smokers (p-value=0.015 by chi-square test), especially in those who did not receive a bone graft (p-value=0.014 by chi-square test). However, no significant difference was found between smokers who received a bone graft and those who did not (p-value=0.072 by chi-square test). The union rate was related to the donor site, with pseudoarthrosis in 33.3% of surgeries with an autologous calcaneal bone graft (p-value=0.011). Conclusion: Smoking increased the likelihood of pseudoarthrosis in subtalar arthrodesis by 2.5-fold, and pseudoarthrosis is related to the autologous bone graft donor site. Level of Evidence III; Therapeutic studies; Comparative Retrospective Study. 

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 ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS

2017 ◽  
Vol 25 (5) ◽  
pp. 183-187 ◽  
Author(s):  
ASHISH SHAH ◽  
SAMEER NARANJE ◽  
IBUKUNOLUWA ARAOYE ◽  
OSAMA ELATTAR ◽  
ALEXANDRE LEME GODOY-SANTOS ◽  
...  
Keyword(s):  
Bone Graft ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Case Series ◽  
Bone Grafts ◽  
Union Rate ◽  
Level Of Evidence ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Bone Graft Substitutes

ABSTRACT Objectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.

scholarly journals TL 18097 - Role of bone graft and bone graft substitutes in isolated subtalar joint arthrodesis

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 80S
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Ibukunoluwa Araoye ◽  
Osama Elattar ◽  
Sameer Naranje ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Graft ◽  
Subtalar Joint ◽  
Bone Grafts ◽  
Union Rate ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Subtalar Arthritis ◽  
Bone Graft Substitutes

Introduction: Subtalar joint (STJ) arthrodesis is a well-established operative procedure in the treatment of subtalar arthritis and hindfoot deformities. Nonunion remains an important complication, with an incidence and role of risk factors varying in the literature. Recent reports have highlighted a decrease in overall union rates between 96% and 100% to 84%, further strengthening the need for an understanding of risk factors that may be implicated in nonunion rates. Some possible factors have been identified, including smoking, revision surgery, the presence and extent of devascularized bone, and previous ankle joint fusion. Current practice suggests that using bone grafts or bone graft substitutes decreases the risk of its occurrence. Objective: To compare union rates of isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all operations. Graft materials included β-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft and an 83% (78/93) union rate with bone graft use. The odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the nongraft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis.

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

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.

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.

scholarly journals Outcomes Following Calcaneal Autograft with a Reaming Graft Harvester

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Travis M. Langan ◽  
Devon Consul ◽  
Rona Law ◽  
Christopher F. Hyer
Keyword(s):  
Bone Graft ◽  
Complication Rate ◽  
Intraoperative Complications ◽  
Donor Site ◽  
Major Complication ◽  
Autogenous Bone ◽  
Foot And Ankle ◽  
Moderate Amount ◽  
Radiographic Findings

Category: Hindfoot Introduction/Purpose: Autogenous bone graft remains the standard bone graft in foot and ankle surgery when filling a bone void or adding biology to an arthrodesis site. Harvesting autograft can have serious donor site morbidity with an average complication rate of 8% and reports as high as 25%. Complications range from persistent pain to severe infection. Most procedures in the foot and ankle require only a small volume of graft. Using a small reaming graft harvester, surgeons can harvest autograft from the ipsilateral calcaneus. This is done within the same surgical field and requires minimal additional operative time. The purpose of this article is to review a population of patients who underwent calcaneal autograft harvesting with a reaming graft harvester and evaluate the outcomes of the procedure. Methods: From August 2015 to February 2018, all patients who underwent calcaneal autograft harvesting by a single surgeon were identified and reviewed. Patients were included if they had autograft harvested from the calcaneus on the ipsilateral operative limb using a reamer bone graft harvester and if they had complete clinical follow up of at least 6 months. Patients were excluded if they had autograft from a site other than the ipsilateral calcaneus, had a previous harvest from the ipsilateral calcaneus, or if they did not have full follow up of at least 6 months. Outcomes of interest were major and minor complications, intra- operative complications, and long term radiographic findings. Patients required graft for numerous primary procedures including a variety of arthrodesis or filling of bone voids. Postoperative protocols and return to weightbearing times varied with the accepted protocols for the primary procedure. Results: 300 patients were identified and met inclusion criteria. Average follow up was 12.6 months. There was 1 major complication (0.3%) consisting of a calcaneal stress fracture that healed with a period of 4 weeks of non weightbearing followed by 4 weeks of protected weightbearing. There were 3 minor complications (1%) consisting of transient painful scar and medial heel pain that all resolved uneventfully. There were no intraoperative complications while performing the 300 procedures. There were no incidences of neurovascular damage. Of the patients with over 1 year radiographic follow up, all harvest sites were still visible on lateral plain film radiographs. Conclusion: Using a small reamer to harvest calcaneal autograft for foot and ankle surgeries that require a small to moderate amount of bone graft is safe and effective. Approximately 4 cc of graft can be harvested very quickly without needing to prepare another surgical site for harvesting. The complication rate for harvesting calcaneal autograft was found to be extremely low in this study, despite the harvest site remaining visible on radiographs past 1 year. The proposed technique can be extremely useful to the foot and ankle surgeon.

Distal Tibia Bone Graft for Arthrodesis of the Foot and Ankle

1995 ◽  
Vol 16 (4) ◽  
pp. 187-190 ◽  
Author(s):  
Marc B. Danziger ◽  
Richard V. Abdo ◽  
J. Elliot Decker
Keyword(s):  
Bone Graft ◽  
Disease Transmission ◽  
Donor Site ◽  
Distal Tibia ◽  
Iliac Crest Bone Graft ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Foot And Ankle ◽  
Ankle Motion ◽  
Donor Site Pain

Forty patients since 1988 have had distal tibial bone grafting for 41 arthrodeses of the foot and ankle. Bone graft is obtained through a cortical window made just above the medial metaphyseal distal tibial flare. Average follow-up was 23.3 months. Forty of 41 arthrodesis sites fused; there was only one nonunion. There were no delayed unions. There were no complications at the donor site based on patient examination and radiographs. Ipsilateral ankle motion was not affected by the bone graft procedure. Cited complications from iliac crest bone graft include donor site pain, blood loss, heterotopic bone formation, pelvic instability, iliac hernia, infection, fracture, and deformity. Complications with allografts include disease transmission and immune response. These are avoided by using locally obtained distal tibia autograft for arthrodeses in the foot and ankle.

scholarly journals Bone graft donor site infection with a rare organism, Aeromonas Hydrophila. A typical location, presentation and organism with 2 years follow-up. Case report

2018 ◽  
Vol 51 ◽  
pp. 154-157 ◽  
Author(s):  
Obada Hasan ◽  
Wajiha Khan ◽  
Muneeba Jessar ◽  
Aly Zaheer Pathan ◽  
Riaz Hussain Lakdawala
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Aeromonas Hydrophila ◽  
Donor Site ◽  
Site Infection ◽  
Graft Donor

scholarly journals Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988426 ◽  
Author(s):  
John T. Stranix ◽  
Merisa L. Piper ◽  
Said C. Azoury ◽  
Geoffrey Kozak ◽  
Oded Ben-Amotz ◽  
...  
Keyword(s):  
Free Flap ◽  
Femoral Condyle ◽  
Donor Site ◽  
Case Series ◽  
Medial Femoral Condyle ◽  
Flap Reconstruction ◽  
Foot And Ankle ◽  
Osseous Union ◽  
Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

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