Effects of teriparatide on fusion rates in patients undergoing complex foot and ankle arthrodesis

Lee, Hee Seop; Park, Jung Ho; Kim, Soo Hyun; Koo, Bum Hwan; Kim, Hak Kyu; Yang, Se Hyun; Choi, Gi Won

doi:10.1016/j.fas.2019.10.002

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…7 Interestingly, in contrast to the same study listed above, this systematic review found that TNJ joints had the highest CT-confirmed union rates at 90% whereas they found TNJ joints had the worst fusion among joints at 79.6%. 7 CT provides the practitioner an indepth 3-dimensional analysis of the fused joint allowing for All patients 1,3-5,10-14, [16][17][18][19][20]24,26,28,31,33,35,37,39,41,42 1015 0.79 0.70 0.88 11.99 -91.81 All joints 1,[3][4][5][9][10][11]13,14,16,18,19,[26][27][28]31,35,37,41,42 1301 0.83 0.73 0.93 9.00 -100.07 Ankles 3,5,17,18,32,37 237 0.86 0.73 0.98 1.61 -209.70 TTC 1,3,4,14,16,…”

Section: Discussionmentioning

confidence: 99%

CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review

et al. 2023

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Background: Ankle, hindfoot, and midfoot arthrodesis surgeries are standard procedures performed in orthopaedics to treat pain and functional disabilities. Although fusions can effectively improve pain and quality of life, nonunions remain a significant concern for surgeons. With the increased availability of computed tomography (CT), more surgeons rely on this modality for increased accuracy in determining whether a fusion was successful. The objective of this study was to report the rates of CT-confirmed fusion following ankle, hindfoot, or midfoot arthrodesis. Methods: A systematic review was performed using EMBASE, Medline, and Cochrane central register from January 2000 to March 2020. Inclusion criteria included studies with adults (<18 years) that received 1 or multiple fusions of the ankle, hindfoot, or midfoot. At least 75% of the study cohort must have been evaluated by CT postoperatively. Basic information was collected, including journal, author, year published, and level of evidence. Other specific information was collected, including patient risk factors, fusion site, surgical technique and fixation, adjuncts, union rates, criteria for successful fusion (%), and time of CT. Once data were collected, a descriptive and comparative analysis was performed. Results: Included studies (26, n = 1300) had an overall CT-confirmed fusion rate of 78.7% (69.6-87.7). Individual joints had an overall fusion rate of 83.0% (73-92.9). The highest rate of union was in the talonavicular joint (TNJ). Conclusion: These values are lower than previous studies, which found the same procedures to have greater than 90% fusion rates. With these updated figures, as confirmed by CT, surgeons will have better information for clinical decision making and when having informed consent conversations.

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Section: Discussionmentioning

confidence: 99%

CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review

et al. 2023

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“…Notable heterogeneity was noticed among the non-RCT studies comparing the effectiveness of various bone graft options and orthobiologics in the healing rates and functional outcomes after foot and ankle arthrodesis. [15][16][17][18]20,21,[23][24][25][26]30,32 The heterogeneity among those studies can be attributed to the different types of bone grafts reported, the various combinations of autograft or allograft tissue with biologic molecules, lack of more than one study analyzing the effect of a certain biologic agent or medication on bone healing in ankle/foot fusion surgery (except for the BMP, see section above), and inconsistency in the reported clinical outcomes. [15][16][17][18]20,21,23,24,27,30,32 More research is necessary to understand the role of allograft bone tissue and/or orthobiologics as alternatives to autograft use to facilitate bone healing in patients undergoing foot and ankle arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

“…These patients subsequently received teriparatide after their revision surgery and subsequently achieved union. 26 In a different study including 68 patients, Devries et al found similar nonunion rates between patients who underwent ankle and hindfoot arthrodesis using allograft morphogenetic protein (AMP; OSTEOAMP; Bioventus LLC) versus those without AMP. 17 In this study, patients in the AMP group had a significantly lower complication rate compared with patients in the non-AMP group (13.8% vs 35.9%, P = 0.04).…”

Section: Other Biologic Agentsmentioning

confidence: 98%

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Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review

Bolia,

Covell,

Tan

2024

JAAOS Glob Res Rev

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Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.

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“…There might be a role for preoperative optimization with consideration of improving vitamin D levels and/or consideration of supplementation with anabolic drugs such as teriparatide to improve bone healing; however, the evidence to support this remains sparse at this time. 21,34 In terms of surgical options, it seems clear that there should be future consideration of either alternative fixation methods, such as intramedullary devices, or fusion should be avoided altogether through the use of total ankle replacement as an alternative primary procedure if not contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Association of Preexisting Triple Fusion and Arthroscopic Ankle Arthrodesis nonunion

et al. 2023

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Background: Arthroscopic ankle arthrodesis (AAA) is a successful treatment for end-stage ankle arthritis. A significant early complication of AAA is symptomatic nonunion. Published nonunion rates range from 8% to 13%. Longer term, there is concern that it predisposes to subtalar joint (STJ) fusion. To better understand these risks, we undertook a retrospective investigation of primary AAA. Methods: All adult AAA cases conducted at our institution over a 10-year period were reviewed. A total of 284 eligible AAA cases in 271 patients were analyzed. The primary outcome measure was radiographic union. Secondary outcome measures included reoperative rate, postoperative complications and subsequent STJ fusion. Univariate and multivariate logistic regression analysis was performed to identify nonunion risk factors. Results: The overall nonunion rate was 7.7%. Smoking (odds ratio [OR] 4.76 [1.67, 13.6], P = .004) and previous triple fusion (OR 40.29 [9.46, 171.62], P < .001) were independent risk factors on univariate analysis. Only prior triple fusion persisted as a major risk factor associated with nonunion on multivariate analysis (OR 18.3 [3.4, 99.7], P < .001). Seventy percent of patients with a previous triple fusion went on to develop nonunion compared to 5.5% of those without. Increasing age, obesity, surgical grade, diabetes, postoperative weightbearing plan, steroid use, and inflammatory arthropathy were not significant risk factors. The leading cause of reoperation was hardware removal (18%). There were 5 superficial (1.8%) and 4 deep (1.4%) infections. Eleven (4.2%) required subsequent STJ fusion. The “survivorship” of STJ post AAA was 98%, 85%, and 74% at 2, 5, and 9 years, respectively. Conclusion: As the largest study of AAA in the literature, our findings suggest prior triple fusion is a major independent risk factor for AAA nonunion. These patients should be counseled of this high risk and may benefit from alternative surgical options. Level of Evidence: Level III, retrospective cohort study.

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Effects of teriparatide on fusion rates in patients undergoing complex foot and ankle arthrodesis

Cited by 7 publications

References 28 publications

CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review

CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review

Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review

Association of Preexisting Triple Fusion and Arthroscopic Ankle Arthrodesis nonunion

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