Clinical assessment of 115 cases of hindfoot fusion with two different types of graft: Allograft+DBM+bone marrow aspirate versus autograft+DBM

tIntroduction: Nonunion is a common complication (15%) of hindfoot and ankle arthrodesis. Autograftcan improve the fusion rate because of its osteoconductive, osteoinductive and osteogenic properties.However, autograft harvesting is a source of morbidity. One alternative is to combine allograft with dem-ineralized bone matrix (DBM) and iliac bone marrow aspirate (BMA). This combination graft has similarbiological properties to healthy bone. When used alone, allograft has osteoconductive and sometimesstructural properties. DBM provides osteoinduction and improves the osteconductivity. BMA adds cellsand thereby osteogenic potential.Hypothesis: Given its intrinsic properties, allograft-DBM-BMA is as effective as autograft-DBM treatmentwhile simplifying the clinical practice.Material and methods: One hundred and fifteen cases of ankle and hindfoot arthrodesis were studied in82 patients divided in two groups: autograft-DBM vs allograft-DBM-BMA. Treatment effectiveness wasassessed using clinical (time to fusion, fusion rate) and radiological (trabecular bone bridge, disappearanceof joint space) criteria. A CT scan was done in 60% of cases when fusion could not be confirmed using theclinical and radiological criteria.Results: There was no significant difference between the two groups in terms of fusion rate, time to fusion,number of heterotopic ossifications, revision rate and quantity of DBM used. The nonunion rate was 18%in the autograft group and 13% in the allograft group. The infection rate was 11% in the autograft and 4%in the allograft group.Discussion: Allograft-DBM-BMA is an alternative to autograft-DBM that provides similar effectivenesswithout increasing the number of nonunion or complications. Osteonecrosis and surgical revision arerisk factors.Level of evidence: III retrospective study