Revisional Hindfoot and Ankle Arthrodesis Using Recombinant Human Platelet-Derived Growth Factor and Beta-Tricalcium Phosphate
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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
Background: The overall incidence of nonunion following primary arthrodesis in foot and ankle surgery is approximately 11%, with higher rates expected for revisional arthrodesis. Use of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) combined with beta-tricalcium phosphate (β-TCP) in primary hindfoot and ankle arthrodesis results in comparable fusion rates, less pain, and fewer side effects compared to autograft. This study evaluated the use of rhPDGF-BB/β-TCP in revisional arthrodesis in hindfoot and ankle reconstruction surgery.
Methods: The charts of patients with at least 12 months follow-up who had undergone revisional arthrodesis supplemented with rhPDGF-BB/β-TCP of the talonavicular, calcaneocuboid, subtalar, or ankle joints were retrospectively reviewed. Comorbidities included Charcot neuroarthropathy (42%), neuropathy (33%), diabetes (33%), hypertension (33%) and gastroesophageal reflux disease (8%).
Results: Twelve patients were included, of which 11 (91.7%) achieved union. The mean time to fusion was 12.9±1.9 weeks and to return to activity was 16.6±2.8 weeks. One patient developed a nonunion of the talonavicular joint. No complications related to the grafting material were observed. There were 2 infected hematomas, both of which went on to fusion.
Conclusion: Use of rhPDGF-BB/β-TCP is a viable alternative to autograft for revisional rearfoot arthrodesis, even in high-risk patients, without the pain and morbidity associated with autograft harvesting.
