Orthobiologics in Foot and Ankle Arthrodesis: A Systematic Review

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

“…29 The surgical methods used in the included studies in this review and the indications for fusion were variable, and this constitutes a major limitation. 7,23,25,26,32 Posttraumatic osteoarthritis or primary osteoarthritis was likely the most common indication for ankle fusion; however, patients with other diagnosis such as rheumatoid arthritis or Charcot disease were also included in the included studies, but the outcomes were not analyzed by surgical indication. 4,11,[15][16][17]31,32 In the surgical techniques, there was variability in the fixation construct used among the included articles and occasionally among the patients included in the same study population such as plate and screws, screws only, or intramedullary nails and/or combination of the above.…”

“…31 The use of allograft tissue has been associated with increased cost and the potential risk of immune reaction from the host that may result in catastrophic complications after foot or ankle fusion. 7 Synthetic grafts such as the rhPDGF-BB/b-TCP or B2A products have been used in foot and ankle fusion surgery during the last decade in an effort to overcome the limitations associated with the use of autograft such as tissue availability and variability, prolonged surgical time, and complications associated with donor site morbidity. In the largest trial comparing the results between patients who underwent ankle/hindfoot fusion using rhPDGF-BB/b-TCP versus autograft, the radiographic and clinical fusion rates using rhPDGF-BB/ b-TCP were deemed noninferior compared with autograft.…”

“…4 The use of the RIA device to obtain autograft tissue has been popularized; however, this procedure is associated with increased cost and surgical time. 7,31 This current review provides evidence that the use of allograft tissue and/or orthobiologics to enhance bone healing can result in comparative clinical and radiographic outcomes as autograft in foot and ankle fusion surgery. 7 Allograft bone tissue is mainly used for its osteoconductive properties in patients undergoing foot and ankle fusion procedures.…”

“…7,31 This current review provides evidence that the use of allograft tissue and/or orthobiologics to enhance bone healing can result in comparative clinical and radiographic outcomes as autograft in foot and ankle fusion surgery. 7 Allograft bone tissue is mainly used for its osteoconductive properties in patients undergoing foot and ankle fusion procedures. Allograft tissue is readily available and can be provided in different forms such as powder, patty, bone chips, and pellets, facilitating its application.…”

“…Given the high heterogeneity in the literature and the rapidly expanding research on this topic, [5][6][7] we only included comparative studies analyzing the outcomes after ankle or foot arthrodesis using different types of bone grafts, with primary focus on articles comparing newer biologic evidence against autograft, which remains the current benchmark.…”