Incidence of Complications With Precontoured Allograft Wedges in Foot and Ankle Surgery.

Background: Precontoured cancellous allograft wedges have gained popularity in foot and ankle procedures in recent years because of their ease of use and ability to decrease operative time. A high rate of resorption of such wedges was noted anecdotally by the senior authors, particularly in 2022. The purpose of this study was to identify the resorption and complication rates of precontoured allograft wedges over time.

Methods: A retrospective review was performed of patients who had a precontoured allograft wedge from a single source implanted during foot and ankle surgery between 2017 and 2022 at a single institution. Patient demographics, indication for graft use, and fixation method were obtained from chart review, and differences between patients with and without nonunion were analyzed. Radiographic review was completed to identify patients with graft resorption and/or nonunion.

Results: Of the 334 wedges implanted, 24 grafts (7.2%) resorbed and an additional 10 wedges (2.9%) developed a nonunion without resorption. Resorption was noted as early as 5.7 weeks postoperatively and as late as 36.6 weeks postoperatively. Older patient age, body mass index (BMI) >30, and the Lapidus graft type were significantly associated with greater risk of resorption or nonunion.

Conclusion: We observed an overall radiographic complication rate of 10% with the use of precontoured cancellous wedges. Older age, BMI >30, and Lapidus wedge type were associated with increased risk of radiographic complication. Patients should be counseled on the risk of resorption and nonunion, and caution should be exercised when contemplating the use of precontoured allograft cancellous wedges in foot and ankle surgery.