Fresh-frozen structural allografts in the foot and ankle

Background: The purpose of this study was to review the results of using structural fresh-frozen femoral head allografts in foot and ankle procedures. These grafts were used in order to restore more normal dimensions of the foot and ankle following surgery or trauma and to treat arthritis or deformity in situations in which conventional cancellous graft would not be sufficient. Methods: Between January 1995 and December 1998, seventy-five foot and ankle operations were performed with use of structural allograft in seventy-three patients with an average age of forty-six years. The graft was used in conjunction with procedures such as arthrodesis of the subtalar joint (twenty-eight procedures) and osteotomy of the calcaneus (eleven procedures). Risk factors identified preoperatively included diabetes and neuropathy, smoking, osteonecrosis, and multiple previous operations. Each operation was performed in a standard manner, with rigid internal fixation. The mean structural dimension (height or length) of the graft was 1.85 cm. Healing was determined by the absence of swelling and warmth and by the presence of trabeculation across the arthrodesis or osteotomy site on both sides of the allograft as seen radiographically. Results: Healing occurred, at a mean of 4.0 months, after 92% (sixty-nine) of the seventy-five procedures. Once the graft was integrated, there was no evidence of graft resorption or subsidence at a mean of 3.5 years postoperatively. Nine of the seventy-three patients had a superficial wound complication (dehiscence or infection), and a deep infection developed in two patients. Conclusions: Use of structural allografts is appropriate for reconstructive procedures in the foot and ankle. The grafts may be used successfully, with a relatively low complication rate, in patients with risk factors for less satisfactory bone-healing. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.