Is the regular use of iliac crest cancellous bone in foot and ankle arthrodesis versus correction justifiable? A comparison study of fusion rate and complications

Background and aim

Pseudarthrosis is a major consequence of foot and ankle surgery, frequently necessitating extra treatment and imposing significant patient and economic issues. Bone defects and quality both have an impact on bone healing. Grafts are commonly utilized to bridge defects or rectify axis, and both autologous and allogeneic materials are accessible. Because of its high complication rate and patient burden, autologous bone transplantation from the iliac crest is being questioned. This retrospective study seeks to determine if these drawbacks exceed the benefits of osteoconductive and osteoinductive effects.

Materials and methods

A retrospective study analyzed patients who underwent foot and ankle surgery and were treated with a tricortical iliac crest chip. The study included patients with a follow-up period of at least six months and analyzed X-ray images. The surgical procedure for removing the chip was standardized, with the iliac crest marked, skin incisions made, wound preparation, and muscle parts exposed. A hemostyptic was inserted, and the wound closed in layers. A subcutaneous drain was inserted, and a pain catheter was inserted percutaneously. All patients were treated as inpatients, with mobilization depending on the surgical treatment.

Results

The study examined autologous bone grafting from the iliac crest for a variety of diagnoses, including calcaneal lengthening osteotomy (22 %), arthrodesis of the tarsometatarsal (TMT) II and III joints (14 %), and revision surgery following pseudarthrosis with interposition (11 %). Nicotine use was reported in 18.45 % of patients, with rheumatoid arthritis in 14 %. Bony consolidation was 97 %, including three incidences of pseudarthrosis. The local complication rate at the iliac crest was 3 %, with three occurrences of seroma, sutured drain, and prolonged hypesthesia. No operational revisions were made.

Conclusion

Our study proposes autologous bone chip removal from the anterior iliac crest as a therapeutic alternative because of its robust mesenchymal cells and diverse chip structure.