Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
In various arthrodesis procedures about the foot and ankle, it has become standard practice to utilize bone grafting strategies such as autograft and/or allograft. While autograft has been considered gold standard, newer allograft mixtures containing osteoconductive, osteoinductive and osteogenic factors may be a reasonable alternative. While allografts are highly accessible and lack harvesting complications seen with autograft use, literature currently lacks robust comparisons of outcomes following midfoot and hindfoot arthrodesis procedures. The current study pursued comparisons of the rate of fusion, complication, and improvement in patient reported outcomes for patients treated with allograft, autograft, a combination of allograft and autograft, or no bone graft for midfoot and hindfoot arthrodesis.
Methods:
A retrospective review was performed on patients who underwent midfoot or hindfoot arthrodesis between March 2021 and May 2023 at a single academic institution. All patients were > 18 years of age at the time of surgery and all were followed > 12 months after their procedure. Allografts utilized included: Augment® (Wright Medical Group) with Bio4TM (Stryker) and Vivigen® (DePuy Synthes). A total of 197 joints in 134 patients were included in the study. Demographic information, graft specifications, Patient Reported Outcome Measurement Information System (PROMIS) scores, and postoperative complications were recorded for each patient. Outcomes were compared in relation to grafting strategy and with respect to location of procedure (midfoot vs. hindfoot).
Categorical and continuous data were compared using Chi-squared test and analysis of variance (ANOVA), respectively. All p< 0.05 (*) were considered statistically significant.
Results:
In midfoot procedures, there was no correlation between grafting material and nonunion. However, in hindfoot procedures, those who received allograft or autograft alone had significantly fewer occurrences of nonunion in comparison to those who received allograft + autograft or no bone graft (p < 0.001*). Amongst all patients who received allograft, a significant increase in union rate was observed (94.5%, p=0.05*) in comparison to patients who received autograft (85%), allograft + autograft (80%), or no bone graft (81.7%). There was an increase in wound complications observed in patients who underwent hindfoot arthrodesis in comparison to midfoot arthrodesis (p=0.019*). Similarly, those who received allograft + autograft had a higher rate of wound dehiscence in comparison to all other graft cohorts (p=0.019*).
Conclusion:
An improved rate of fusion was observed in patients who underwent arthrodesis procedures implementing newer generation allografts in comparison to autograft, allograft + autograft, or no bone graft. Data from the current study indicate newer generation allografts may be a safe and effective alternative to the gold standard autologous bone graft for midfoot and hindfoot arthrodesis procedures. The current retrospective study is limited in nature; future expansion of the current study may include prospective or randomized controlled trials to better assess differences in outcomes between these grafting strategies.
Table 1. Outcome Summary per bone grafting material and location of arthrodesis procedure. Continuous data are represented as a mean +/- SD; noncontinuous data are represented as a count (% N). All p < 0.05 were considered to be significant, as indicated by (*).