A Retrospective Comparison of Clinical and Patient-Reported Outcomes in Foot and Ankle Arthrodesis Procedures Using Two Cellular Bone Allografts
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Copyright: © 2020 . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: The purpose of this retrospective study was to compare clinical and patient-reported outcomes following foot and ankle arthrodesis (FAA) procedures using two cellular bone allografts containing viable lineagecommitted bone forming cells (V-CBA) versus mesenchymal stem cells (T-CBA), each within an osteoconductive matrix mixed with demineralized bone. Methods: A total of 47 consecutive patients underwent foot and ankle arthrodesis procedures: 31 patients received V-CBA and 16 patients received T-CBA. Baseline characteristics were summarized. Clinical (rates of ankle and subtalar [when applicable] fusion at 6 months and rates of complications) and patient-reported outcomes (satisfaction, and pre- and postsurgical visual analog scale [VAS] for pain) were compared between the two grafts. Results: The use of V-CBA led to significantly higher rates of ankle fusion at 6 months (100% vs. 50.00%; P<0.0001), equitable subtalar fusion rates (89.29% vs 71.43%, ns), and significantly fewer complications (6.45% vs 62.50%; P<0.0001), in spite of patient comorbidities and lifestyle characteristics that would be expected to negatively affect such outcomes. Additionally, all of the patients who received V-CBA were satisfied with their postsurgical outcomes (versus a significantly lower 68.75% in the T-CBA group; P=0.0028), and they reported a significantly lower average postsurgical VAS of 1.40 points (a reduction of 7.52 points from presurgical), compared with 3.15 points in the T-CBA group (4.84-point reduction; P=0.0099). Conclusion: Clinical and patient-reported outcomes were significantly improved following the use of V-CBA versus T-CBA, except for subtalar fusion rates, which were equitable. The results of this study support preclinical findings suggesting that viable lineage-committed bone cells may be a more suitable choice for enhancing bone fusion compared to MSCs, and suggest that V-CBA in FAA procedures can result in early fusion with minimal complications, less influence from relevant comorbidities and lifestyle risks, and more successful clinical and patientreported outcomes.
