The available evidence on demineralised bone matrix in trauma and orthopaedic surgery

Abstract

ObjectivesThe aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery.MethodsA total of 17 DBM products were used as search terms in two available databases: Embase and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. All articles that reported the clinical use of a DBM-product in trauma and orthopaedic related surgery were included.ResultsThe literature search resulted in 823 manuscripts of which 64 manuscripts met the final inclusion criteria. The included manuscripts consisted of four randomised controlled trials (level I), eight cohort studies (level III) and 49 case-series (level IV). No clinical studies were found for ten DBM products, and most DBM products were only used in combination with other grafting materials. DBM products were most extensively investigated in spinal surgery, showing limited level I evidence that supports the use Grafton DBM (Osteotech, Eatontown, New Jersey) as a bone graft extender in posterolateral lumbar fusion surgery. DBM products are not thoroughly investigated in trauma surgery, showing mainly level IV evidence that supports the use of Allomatrix (Wright Medical, London, United Kingdom), DBX (DePuy Synthes, Zuchwil, Switzerland), Grafton DBM, or OrthoBlast (Citagenix Laval, Canada) as bone graft extenders.ConclusionsThe clinical level of evidence that supports the use of DBM in trauma and orthopaedic surgery is limited and consists mainly of poor quality and retrospective case-series. More prospective, randomised controlled trials are needed to understand the clinical effect and impact of DBM in trauma and orthopaedic surgery.Cite this article: J. van der Stok, K. A. Hartholt, D. A. L. Schoenmakers, J. J. C. Arts. The available evidence on demineralised bone matrix in trauma and orthopaedic surgery: A systemati c review. Bone Joint Res 2017;6:423–432. DOI: 10.1302/2046-3758.67.BJR-2017-0027.R1.

Fibrous Demineralized Bone Matrix (DBM) Improves Bone Marrow Mononuclear Cell (BMC)-Supported Bone Healing in Large Femoral Bone Defects in Rats

“…Various DBM application forms are currently in clinical use. DBM products are used in the form of granules, sponges, strips, injectable putty, paste and paste supplemented with bone chips [ 37 ].…”

Arthroscopic Contribution of Synthetic Graft in Tibiotalocalcaneal Arthroscopic Fusions

“…Demineralized bone matrices (DBMs) and the allografts present osteo-conductive and osteo-inductive properties. However, few of these options have evidence to support their use as a standalone substitute [ 18 ]. It is known that bone has a remarkable capacity for growth, regeneration and remodeling.…”

The choice between allograft or demineralized bone matrix is not unambiguous in trauma surgery

“…When carriers are added to the commercial products, DBM fraction are lowered, and with less DBM then are less growth factors present, meaning efficacy is reduced. The percentage of DBM by weight of product may vary from 17% in Grafton DBM and up to 100% DBM in Accell TBM, a product that is without carriers [12,20] .…”

“…Experiences from the clinic and from controlled studies are thus important. In trauma surgery, the evidence from existing studies for the use of allograft and DBM remains low [20,23] .…”