The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery

Jonathan R Peterson; Fangyu Chen; Eugene Nwankwo; Travis J Dekker; Samuel B Adams

doi:10.1177/2473011419849019

The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery

Foot Ankle Orthop. 2019 Jul 10;4(3):2473011419849019. doi: 10.1177/2473011419849019. eCollection 2019 Jul.

Authors

Jonathan R Peterson¹, Fangyu Chen¹, Eugene Nwankwo¹, Travis J Dekker¹, Samuel B Adams¹

Affiliation

¹ Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Abstract

Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments.

Level of evidence: Level V, expert opinion.

Keywords: BMP; PDGF; allograft; autograft; bone marrow aspirate; orthobiologics; stem cells.

Publication types

Review