Allograft Cellular Bone Matrix as an Alternative to Autograft in Hindfoot and Ankle Fusion Procedures

This report summarizes the radiographic results of Osteocel Plus in 20 hindfoot and ankle fusions at a single center. The patient population was 40% female with an average age of 57.9 +/- 16.1 years. Average body mass index was 33.8 +/- 9.1. Risk factors included 3 smokers and 6 patients with diabetes. Primary surgical indications included trauma (50%), Charcot arthropathy (15%), foot drop with osteoarthritis (20%), primary osteoarthritis (10%), and total talar extrusion (5%). Nine patients had a history of prior hindfoot surgery in the same foot; however, only 2 of the cases reported in this series were revisions due to a failed prior surgery; the remaining 7 were treated for correction of a traumatic deformity (n=5) or diagnosis at a new site in the same foot (n=2). Treatment included subtalar joint arthrodesis (50%), ankle arthrodesis (40%), triple fusion (5%), and tibial-calcaneal-calcaneal-cuboid arthrodesis (5%). Solid fusion was observed in 100% of patients by the 6-month evaluation. Average time to fusion was 13.5 weeks. Although patients with a prior surgery trended toward a longer time to fusion than patients who underwent their first hindfoot and ankle procedure (14.4 +/- 5.3 vs. 12.6 +/- 5.7 weeks), the difference was not statistically significant (p=.47). There was no evidence of graft rejection or failure. This series demonstrates that mesenchymal stem cell-based bone allograft is a safe and effective bone-healing material with a high radiographic success rate in foot and ankle arthrodeses with successful and timely fusion rates. (C) 2012 by the American College of Foot and Ankle Surgeons. All rights reserved.