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Maharjan L, Washburn F, Tran B, Pyle C. Arthroscopic Tibiotalar Arthrodesis Using an Arthroscopic Autologous Tissue Collector: A Technique Guide. Arthrosc Tech 2024; 13:102979. [PMID: 39036393 PMCID: PMC11258869 DOI: 10.1016/j.eats.2024.102979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/03/2024] [Indexed: 07/23/2024] Open
Abstract
Tibiotalar arthrodesis is a common procedure performed in patients with ankle arthritis to relieve pain, restore function, and improve the quality of life. Obtaining proper bone-to-bone apposition is crucial to obtaining a solid fusion. Therefore, adequate joint preparation is critical. Open-joint preparation is the standard of care, but arthroscopic arthrodesis is becoming increasingly popular, as it can decrease tissue trauma, postoperative pain, hospital stay, and complications. The addition of bone matrix allograft and autograft also improves healing rates. Use of an arthroscopic autologous tissue collector through standard arthroscopic portals allows harvesting of bone matrix autograft without having to perform additional invasive bone harvesting outside of the affected joint. We present our technique for tibiotalar arthrodesis using an arthroscopic approach with an arthroscopic autologous tissue collector.
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Affiliation(s)
- Laura Maharjan
- Department of Orthopedics, Community Memorial Hospital, Ventura, California, U.S.A
- Graduate Medical Education, Community Memorial Hospital, Ventura, California, U.S.A
| | - Frederic Washburn
- Department of Orthopedics, Community Memorial Hospital, Ventura, California, U.S.A
- Graduate Medical Education, Community Memorial Hospital, Ventura, California, U.S.A
| | - Britni Tran
- Graduate Medical Education, Community Memorial Hospital, Ventura, California, U.S.A
| | - Casey Pyle
- Department of Orthopedics, Community Memorial Hospital, Ventura, California, U.S.A
- Graduate Medical Education, Community Memorial Hospital, Ventura, California, U.S.A
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Bolia IK, Covell DJ, Tan EW. Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00004. [PMID: 38704857 PMCID: PMC11068146 DOI: 10.5435/jaaosglobal-d-23-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.
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Affiliation(s)
- Ioanna K Bolia
- From the Department of Orthopeadic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Dr. Bolia, and Dr. Tan), and the Danville Orthopeadics and Sports Medicine, Danville, KY (Dr. Covell)
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Frederick RM, Sarfani S, Chiu CY, Hayes T, Bettin C, Grear B, Richardson D, Murphy GA. Comparing Rates of Fusion and Time to Fusion in Viable Cellular Allograft and Autograft. Foot Ankle Int 2022; 43:1548-1553. [PMID: 36036537 DOI: 10.1177/10711007221119164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Autograft or allograft frequently are used to enhance bone union in foot and ankle surgery. Viable cellular bone allograft uses viable cells and bone scaffolding in a gel base, but uncertainty remains around allograft's greater efficacy than autograft regarding rates of fusion (ROF) and time to fusion (TTF). METHODS Autograft, viable cellular allograft, and viable cellular allograft with autograft were compared in 199 forefoot, midfoot, and hindfoot arthrodeses performed over a 6-year period. Data collected from electronic medical records and radiographs were analyzed to determine ROF and TTF as well as rates of revision surgery for delayed or nonunion and compared among groups. RESULTS Eighty-seven patients comprised the autograft group, 81 the allograft group, and 31 the combined group. No significant differences were noted in patient demographics among the groups. No statistically significant differences in ROF were noted among the 3 groups, with 86% (75 of 87) fusion in the autograft group, 93% (75 of 81) in the allograft group, and 84% (26 of 31) in the combined group (P = .20). After conducting a multivariate analysis, we found no statistically significant difference for allograft or combined graft on TTF (P = .1379 and .2311, respectively). No significant difference was found in rate of revision surgery for nonunion, which was 1.2% (1 of 81) in the allograft group, 3.4% (3 of 87) in the autograft group, and 6.5% (2 of 31) in the combined group (P = .3). CONCLUSION No significant difference was found in ROF, TTF, or rate of revision surgery when comparing viable cellular allograft to autograft or combined allograft-autograft. Viable cellular allograft may be a reasonable alternative to the gold standard of autograft and should be considered an option in patients undergoing arthrodesis in foot and ankle surgery. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Robert M Frederick
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | | | - Chi-Yang Chiu
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Tristan Hayes
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Clayton Bettin
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN, USA
| | - Benjamin Grear
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN, USA
| | - David Richardson
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN, USA
| | - G Andrew Murphy
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN, USA
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Cates NK, Mayer A, Tenley J, Wynes J, Tefera E, Steinberg JS, Kim PJ, Weinraub GM. Double Versus Triple Arthrodesis Fusion Rates: A Systematic Review. J Foot Ankle Surg 2022; 61:907-913. [PMID: 35221217 DOI: 10.1053/j.jfas.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the need for hindfoot arthrodesis is generally accepted in severe deformities, there is a debate whether a double or triple arthrodesis should be performed. The aim of our systematic review is to review the fusion rates and mean time to fusion in double and triple arthrodesis. A total of 184 articles were identified using the keyword search through the database of articles published from 2005 to 2017. After review by 3 physicians, a total of 13 articles met the eligibility criteria. The reason for double or triple arthrodesis within the studies were posterior tibial tendon dysfunction, tarsal coalition, degenerative joint disease, osteoarthritis, rheumatoid arthritis, Charcot Marie Tooth, Multiple Sclerosis, Polio, neuromuscular disorder, cerebral palsy, acrodystrophic neuropathy, clubfoot, post-traumatic, and seronegative arthropathy (spondyloarthritis). Within these 13 studies, there were a total of 343 (6-95) subjects extremities operated on. The overall fusion rate for double arthrodesis was 91.75% (289/315) compared to 92.86% (26/28) triple arthrodesis fusion rate, p value .8370. The mean time to fusion for double arthrodesis was 17.96 ± 7.96 weeks compared to 16.70 ± 8.18 weeks for triple arthrodesis, p value = .8133. There are risks associated with triple arthrodesis including increased surgical times, lateral wound complications, residual deformity, surgical costs and peri-articular arthritis. Given the benefits of double arthrodesis over triple arthrodesis and the nearly equivalent fusion rates and time to fusion, double arthrodesis is an effective alternative to triple arthrodesis. The authors of this systematic review recommend double arthrodesis as the hindfoot fusion procedure of choice.
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Affiliation(s)
- Nicole K Cates
- Fellowship Trained Foot and Ankle Surgeon, Hand & Microsurgery Medical Group, San Francisco, CA.
| | - Alissa Mayer
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jonathan Tenley
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jacob Wynes
- Asistant Professor, Fellowship Program Director, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Eshetu Tefera
- Department of Biostatistician and Biomedical Informatics, MedStar Health Research Institute, Washington, DC
| | - John S Steinberg
- Co-Director of the Center for Wound Healing and Director of Podiatric Residency Training Program, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Paul J Kim
- Professor, Attending Physician, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Glenn M Weinraub
- Attending Physician, Department of Orthopaedics, Kaiser Permanente, San Leandro, CA
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Persistent Pain After Hindfoot Fusion. Foot Ankle Clin 2022; 27:327-341. [PMID: 35680291 DOI: 10.1016/j.fcl.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The hindfoot joints consist of the subtalar, talonavicular, and calcaneocuboid (CC) joints. These joints are commonly fused for degenerative changes, deformity correction, inflammatory or neuropathic arthropathy, tarsal coalition, or primarily after trauma. Goals of hindfoot fusion are a painless plantigrade foot capable of fitting in shoes without orthotics or a brace. Many believe that deformity correction is achievable without inclusion of the CC joint. Managing patient expectations is important when counseling a patient especially regarding potential complications.
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Ramanathan D, Emara AK, Pinney S, Bell A, Miniaci-Coxhead SL. Vitamin D Deficiency and Outcomes After Ankle Fusion: A Short Report. Foot Ankle Int 2022; 43:703-705. [PMID: 35012371 DOI: 10.1177/10711007211068785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitamin D deficiency has been postulated as a cause for impaired bone healing and remodeling. The purpose of this study was to assess the potential association between low vitamin D levels and reoperation for nonunion following ankle fusion surgery. METHODS All adult patients (aged ≥18 years) who underwent ankle fusion procedures at a tertiary referral center from January 2010 to January 2019 with available vitamin D levels within 12 months preoperatively were retrospectively reviewed (n = 47). Patients were categorized as vitamin D deficient (<30 ng/mL) vs normal (31-80 ng/mL). The primary outcome was the incidence of reoperation secondary to nonunion. Secondary outcomes included incidence of reoperation not related to nonunion and the need for repeat reoperation. RESULTS The average level in the vitamin D-deficient group (n = 17; 36.2%) was 16.9 vs 46.4 ng/mL in the normal group (n = 30; 63.8%). All recorded reoperations for nonunion occurred exclusively in the vitamin D-deficient cohort (4/17 [23.5%]; P = .013). There were similar reoperation rates for causes other than nonunion (2/17 [11.8%] vs 4/30 [13.3%]; P > .99) and repeat reoperation rates (3/17 [17.6%] vs 1/30 [3.3%]; P = .128) among vitamin D-deficient vs normal patients. CONCLUSION Vitamin D deficiency may be associated with an increased risk of reoperation for nonunion after ankle fusion.
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Affiliation(s)
- Deepak Ramanathan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Pinney
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrea Bell
- Department of Internal Medicine, MetroHealth hospital, Cleveland, OH, USA
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Seow D, Yasui Y, Dankert JF, Miyamoto W, Calder JDF, Kennedy JG. Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis: A Systematic Review and Meta-Analysis of Clinical Comparative Studies. J Bone Joint Surg Am 2021; 103:1734-1743. [PMID: 34191761 DOI: 10.2106/jbjs.20.01475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate the efficacy of biological adjuvants in patients managed with hindfoot arthrodesis. METHODS A systematic review of the PubMed and Embase databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with use of specific search terms and eligibility criteria. Assessment of evidence was threefold: level of evidence by criteria as described in The Journal of Bone & Joint Surgery, quality of evidence according to the Newcastle-Ottawa scale, and conflicts of interest. Meta-analysis was performed with fixed-effects models for studies of low heterogeneity (I2 < 25%) and with random-effects models for studies of moderate to high heterogeneity (I2 ≥ 25%). RESULTS A total of 1,579 hindfeet were recruited across all studies, and 1,527 hindfeet were recorded as having completed treatment and follow-up visits. The duration of follow-up ranged from 2.8 to 43 months. Twelve of the 17 included studies comprised patients with comorbidities associated with reduced healing capacity. Based on the random-effects model for nonunion rates for autograft versus allograft, the risk ratio was 0.82 (95% CI, 0.13 to 5.21; I2 = 56%; p = 0.83) in favor of lower nonunion rates for autograft. Based on the random-effects model for rhPDGF/β-TCP versus autograft, the risk ratio was 0.90 (95% CI, 0.74 to 1.10; I2 = 59%; p = 0.30) in favor of lower nonunion rates for rhPDGF/β-TCP. CONCLUSIONS There is a lack of data to support the meaningful use of biological adjuvants as compared with autograft/allograft for hindfoot arthrodesis. The meta-analysis favored the use of autograft when compared with allograft but favored rhPDGF/β-TCP when compared with autograft in the short term. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dexter Seow
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - John F Dankert
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - James D F Calder
- Fortius Clinic, London, United Kingdom.,Imperial College, London, United Kingdom
| | - John G Kennedy
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Marmor MT, Matz J, McClellan RT, Medam R, Miclau T. Use of Osteobiologics for Fracture Management: The When, What, and How. Injury 2021; 52 Suppl 2:S35-S43. [PMID: 33549314 DOI: 10.1016/j.injury.2021.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
Osteobiologics are defined as a group of natural and synthetic materials used to augment bone healing. The selection of the most appropriate osteobiologic from the growing list of available options can be a challenging task. In selecting a material, surgeons should weigh a variety of considerations, including the indication for their use (the when), the most suitable substance (the what), and the correct mode of application (the how). This summary reviews these considerations and seeks to provide the surgeon with a basis for informed clinical evidence-based decision-making in their choice of a successful option.
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Affiliation(s)
- Meir T Marmor
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Jacob Matz
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Robert Trigg McClellan
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Ramapaada Medam
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Theodore Miclau
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
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Ordas-Bayon A, Logan K, Garg P, Peat F, Krkovic M. Ankle arthrodesis using the Taylor Spatial Frame for the treatment of infection, extruded talus and complex pilon fractures. Injury 2021; 52:1028-1037. [PMID: 33583592 DOI: 10.1016/j.injury.2021.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/29/2020] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of complex pilon fractures and talus fracture-dislocations present several challenges, like avoiding infection, achieving union, management of bone loss and function preservation. METHODS Retrospective cohort review of fourteen patients who underwent ankle arthrodesis (AA) using the Taylor Spatial Frame (TSF) after pilon and talus fracture-dislocations. Ten tibiocalcaneal (TC) and four tibiotalar (TT) fusions were performed. Eleven of these cases were Gustilo III open fractures. Seven cases involved an open extruded talus. Four cases had established infections. There was a mean of 2.7 (range 0 - 8) operations prior to AA using TSF. The primary objective was to determine infection and union rates. Patient-reported outcomes (Short Form 36, SF-36) and functional outcomes (Ankle Osteoarthritis Score, AOS) were the secondary measures. RESULTS Eradication and prevention of deep infection was achieved in all cases. Radiological union was achieved at a mean of 9 months (range 5 - 17). Solid AA was achieved in 12 of 14 cases using the TSF. Two TC fusions required a hindfoot fusion nail to achieve union. Eleven cases had concurrent bone transport, mean of 63 mm (range 33 - 180). Mean time of TSF treatment was 11.1 months (range 6 - 16). One case required delayed amputation. Eight patients were able to fully weight bear unaided after the treatment. Mean SF-36 was 65 (range 35 -100). Mean AOS was 36.5 (range 6.6 - 77.5) with 69.3% of scores graded good to excellent. Mean total number of operations was 5.9 (range 2 - 10). Minimum follow up time was 12 months (range 12 - 56). CONCLUSION AA using TSF can be considered for complex pilon fractures and extruded talus. It has shown to be effective in achieving a solid fusion and infection eradication. While using the TSF in isolation, non-union must be suspected in TC fusions, absence of radiological signs of healing, massive bone loss, and possibly not using bone graft. Patients must be aware that while treatment of these injuries will be prolonged and carries the risk of many potential complications, it provides a good alternative to amputation.
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Affiliation(s)
- Alejandro Ordas-Bayon
- Limb Reconstruction Service, Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, CB2 0QQ, Cambridge, Cambridgeshire, United Kingdom.
| | - Karl Logan
- Limb Reconstruction Service, Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, CB2 0QQ, Cambridge, Cambridgeshire, United Kingdom.
| | - Parag Garg
- Limb Reconstruction Service, Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, CB2 0QQ, Cambridge, Cambridgeshire, United Kingdom.
| | - Fidel Peat
- Limb Reconstruction Service, Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, CB2 0QQ, Cambridge, Cambridgeshire, United Kingdom.
| | - Matija Krkovic
- Limb Reconstruction Service, Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, CB2 0QQ, Cambridge, Cambridgeshire, United Kingdom.
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Damsaz M, Castagnoli CZ, Eshghpour M, Alamdari DH, Alamdari AH, Noujeim ZEF, Haidar ZS. Evidence-Based Clinical Efficacy of Leukocyte and Platelet-Rich Fibrin in Maxillary Sinus Floor Lift, Graft and Surgical Augmentation Procedures. Front Surg 2020; 7:537138. [PMID: 33330603 PMCID: PMC7732646 DOI: 10.3389/fsurg.2020.537138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022] Open
Abstract
Bone augmentation techniques have increasingly been indicated for re-creating adequate bone height and volume suitable for dental implant sites. This is particularly applicable in the severely atrophic posterior maxilla where sinus perforation (ruptured Schneiderian membrane) is a very common complication and sinus floor elevation or lift is frequently considered a standard procedure. The augmentation of the maxillary sinus can be performed with or without grafting biomaterials. Herein, numerous biomaterials and bone substitutes have been proposed, primarily to sustain the lifted space. In addition, cytokines and growth factors have been used to stimulate angiogenesis, enhance bone formation as well as improve healing and recovery period, either as the sole filling material or in combination with bone substitute materials. Within such, is the family of autologous blood extracts, so-called platelet concentrates, which are simply the "product" resulting from the simple centrifugation of collected whole blood samples of the patient, immediately pre-surgery. Platelet-Rich Fibrin (PRF), a sub-family of platelet concentrates, is a three-dimensional (3-D) autogenous biomaterial obtained, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents during the centrifugation process. Today, it is safe to say that, in implant dentistry and oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-classes) are receiving the most attention, essentially due to their simplicity, rapidness, user-friendliness/malleability, and cost-effectiveness. Whether used as the sole "bioactive" filling/additive material or combined with bone substitutes, the revolutionary second-generation PRFs have been very often associated with promising clinical results. Hence, this review aims to provide a 10-years update on the clinical effectiveness of L-PRF when applied/used as the "sole" biomaterial in maxillary sinus augmentation procedures. An electronic search using specific keywords for L-PRF and maxillary sinus augmentation was conducted in three main databases (PubMed-MEDLINE database, Google Scholar and Cochrane library) for the period between January 2009-February 2020. The quest yielded a total of 468 articles. Based on the pre-established strict inclusion/exclusion criteria, only seven articles were deemed eligible and included in the analysis. Surprisingly, of the 5 studies which used de-proteinized bovine bone mineral (DBBM) in combination with L-PRF, 60% acclaimed no significant effects and only 40% declared positive effects. Of the two articles which had used allogenous bone graft, 50% declared no significant effects and 50% acclaimed positive effects. Only one study had used L-PRF as the sole grafting material and reported a positive effect. Likewise, positive effects were reported in one other study using L-PRF in combination with a collagen membrane. Due to the heterogeneity of the included studies, this review is limited by the inability to perform a proper systematic meta-analysis. Overall, most of the published studies reported impressive results of L-PRF application as a grafting material (sole or adjuvant) in maxillary sinus augmentation and dental implant restorative procedures. Yet, distinct technical processing for L-PRF preparation was noted. Hence, studies should be approached with caution. Here in, in sinus lift and treatment of Schneider membrane, the formation of mature bone remains inconclusive. More studies are eagerly awaited in order to prove the beneficial or detrimental effects of PRFs, in general and L-PRFs, in specific; especially in their tissue regenerative potential pertaining to the promotion of angiogenesis, enhancing of cell proliferation, stimulation of cell migration and autocrine/paracrine secretion of growth factors, as well as to reach a consensus or a conclusive and distinct determination of the effect of leukocytes (and their inclusion) on inflammation or edema and pain; a call for standardization in PRFs and L-PRFs composition reporting and regimenting the preparation protocols.
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Affiliation(s)
- Mohamadamin Damsaz
- Dentistry Student Research Committee, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Majid Eshghpour
- Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryouosh Hamidi Alamdari
- Surgical Oncology Research Center, Emam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aida Hamidi Alamdari
- Dentistry Student Research Committee, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ziad Eva Fouad Noujeim
- BioMAT'X R&D&I Laboratory, Universidad de los Andes, Santiago, Chile
- Department of Oral and MaxilloFacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Ziyad Samir Haidar
- BioMAT'X R&D&I Laboratory, Universidad de los Andes, Santiago, Chile
- Programa de Doctorado en BioMedicina, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica (CIIB), Universidad de los Andes, Santiago, Chile
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
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Gagne OJ, Veljkovic AN, Glazebrook M, Penner M, Wing K, Younger ASE. Agonizing and Expensive: A Review of Institutional Costs of Ankle Fusion Nonunions. Orthopedics 2020; 43:e219-e224. [PMID: 32271927 DOI: 10.3928/01477447-20200404-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Nonunion after ankle arthrodesis requiring revision is a challenging operative complication, and bone graft substitutes are costly. This study sought to summarize all institutional expenditures related to the revision of an ankle fusion nonunion, presuming that cost and skin-to-skin time would exceed those of the index surgery. The electronic records from 2 foot and ankle centers were reviewed, leading to a list of patients with 2 or more entries for tibiotalar fusions being generated. A total of 24 cases were found to match the criteria. Demographic factors and skin-to-skin time of the remaining patients were compiled. This cohort included 24 patients (6 female and 18 male) with a mean age of 64 years and body mass index of 30.4 kg/m2. Supplemental clinic visits and investigations were included either after computed tomography to assess union or 365 days after index surgery. Total cost of the revision was calculated from billing codes, length of operation, and period of hospitalization. Postrevision outpatient fees were included as well. The revisions were performed open in all cases, and 21 patients received autograft and/or bone substitute. Mean postoperative hospitalization was 3 days. The additional costs (in US dollars) associated with nonunion were $1061 for imaging, $627 for prerevision visits, $3026 for the revision, $3432 for the hospital stay, and $1754 for postrevision follow-up. The total mean amount was $9683, equivalent to 9 nights of acute inpatient stay. Mean index skin-to-skin time was 114 minutes, being 126 minutes for revisions (P=.26). Additional care related to ankle fusion nonunion represents a financial burden equivalent to 9 nights of acute inpatient stay. The use of an orthobiologic would need to be less than $436 to be cost saving. Revision surgery is not significantly longer intraoperatively than index surgery. [Orthopedics. 2020;43(4):e219-e224.].
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Natural Sources and Applications of Demineralized Bone Matrix in the Field of Bone and Cartilage Tissue Engineering. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1249:3-14. [DOI: 10.1007/978-981-15-3258-0_1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Magnus MK, Iceman KL, Roukis TS. Living Cryopreserved Bone Allograft as an Adjunct for Hindfoot Arthrodesis. Clin Podiatr Med Surg 2018; 35:295-310. [PMID: 29861013 DOI: 10.1016/j.cpm.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hindfoot arthrodesis is a frequently performed procedure by foot and ankle surgeons. The relatively high nonunion rate associated with these procedures has led surgeons to use adjunctive bone graft to help augment osseous union. Cellular bone allografts are a specific type of graft that incorporates osteoconductive, osteoinductive, and osteogenic properties while also eliminating the common disadvantages of autografts and traditional allografts. This article discusses the role of cellular bone allografts in hindfoot arthrodesis procedures, a review of current literature, and a comparison of available products.
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Affiliation(s)
- Mark K Magnus
- Gundersen Medical Foundation, Mail Stop: CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Kelli L Iceman
- Gundersen Medical Foundation, Mail Stop: CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Thomas S Roukis
- Orthopaedic Center, Gundersen Healthcare System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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