Comparison of Anterior and Posterior Iliac Crest Bone Grafts in Terms of Harvest-Site Morbidity and Functional Outcomes

Ahlmann, Elke R.; Patzakis, Michael J.; Roidis, Nikolaos; Shepherd, Lane E.; Holtom, Paul

doi:10.2106/00004623-200205000-00003

Cited by 571 publications

(393 citation statements)

References 29 publications

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“…Another limitation of this study is the use of anterior iliac crest bone graft instead of posterior iliac crest bone graft for comparison. Patients who undergo posterior iliac crest graft harvest have fewer complications and higher graft volumes than patients who undergo anterior iliac crest harvest [1]. Patients who underwent posterior iliac crest harvest could have provided a better control group.…”

Section: Discussionmentioning

confidence: 99%

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Bone Graft Harvest Using a New Intramedullary System

Belthur

Conway

Jindal

et al. 2008

Clinical Orthopaedics &Amp; Related Research

147

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Obtaining autogenous bone graft from the iliac crest can entail substantial morbidity. Alternatively, bone graft can be harvested from long bones using an intramedullary (IM) harvesting system. We measured bone graft volume obtained from the IM canals of the femur and tibia and documented the complications of the harvesting technique. Donor site pain and the union rate were compared between the IM and the traditional iliac crest bone graft (ICBG) harvest. Forty-one patients (23 male, 18 female) with an average age of 44.9 years (range, 15-78 years) had graft harvested from long bones using an IM harvest system (femoral donor site, 37 patients; tibial donor site, four patients). Forty patients (23 male, 17 female; average age, 46.4 years; range, 15-77 years) underwent anterior ICBG harvest. We administered patient surveys to both groups to determine pain intensity and frequency. IM group reported lower pain scores than the ICBG group during all postoperative periods. Mean graft volume for the IM harvest group was 40.3 mL (range, 25-75 mL) (graft volume was not obtained for the ICBG group). Using an intramedullary system to harvest autogenous bone graft from the long bones is safe provided a meticulous technique is used.

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Section: Discussionmentioning

confidence: 99%

“…Many potential donor sites are available for graft harvest, all with recognized major and minor complications [1,4,7,20,23,27]. Sources of relatively large amounts of bone graft (ie, 20-40 cc) are the anterior iliac crest, posterior iliac crest, and the fibula.…”

Section: Introductionmentioning

confidence: 99%

Bone Graft Harvest Using a New Intramedullary System

Belthur

Conway

Jindal

et al. 2008

Clinical Orthopaedics &Amp; Related Research

147

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“…Autograft bone, most commonly harvested from the iliac crest, has remained the historic gold standard graft material [1]. Its use, however, is associated with additional morbidities, such as increased blood loss, wound complications, local sensory deficits, and persistent donor site pain [2].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

et al. 2010

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A prospective, randomized study was performed in an ovine model to compare the efficacy of an anorganic bovine-derived hydroxyapatite matrix combined with a synthetic 15 amino acid residue (ABM/P-15) in facilitating lumbar interbody fusion when compared with autogenous bone harvested from the iliac crest. P-15 is a biomimetic to the cell-binding site of Type-I collagen for bone-forming cells. When combined with ABM, it creates the necessary scaffold to initiate cell invasion, binding, and subsequent osteogenesis. In this study, six adult ewes underwent anterior-lateral interbody fusion at L3/L4 and L4/L5 using PEEK interbody rings filled with autogenous bone at one level and ABM/P-15 at the other level and no additional instrumentation. Clinical CT scans were obtained at 3 and 6 months; micro-CT scans and histomorphometry analyses were performed after euthanization at 6 months. Clinical CT scan analysis showed that all autograft and ABM/P-15 treated levels had radiographically fused outside of the rings at the 3-month study time point. Although the clinical CT scans of the autograft treatment group showed significantly better fusion within the PEEK rings than ABM/P-15 at 3 months, micro-CT scans, clinical CT scans, and histomorphometric analyses showed there were no statistical differences between the two treatment groups at 6 months. Thus, ABM/P-15 was as successful as autogenous bone graft in producing lumbar spinal fusion in an ovine model, and it should be further evaluated in clinical studies.

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“…Gap filling of bony defects can be achieved with autogenous bone grafting; however, the limited availability of autogenous bone and the morbidity associated in graft harvesting has resulted in the search for alternatives, including allograft and bone graft substitutes [1,4,13,14,18,22,26,35]. A bone graft substitute with potential benefit for addressing bone defects around cementless implants is demineralized bone matrix (DBM) [9,20,21].…”

Section: Introductionmentioning

confidence: 99%

The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

Lim

Bobyn

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap healing and porous implant fixation. Questions/purposes We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous implant. Methods We inserted porous titanium implants into the proximal metaphyses of canine femora and humeri, with an initial 3-mm gap between host cancellous bone and implants. We left the gaps empty (control; n = 12) or filled them with either demineralized bone matrix (n = 6) or devitalized demineralized bone matrix (negative control; n = 6) and left them in situ for 4 or 12 weeks. We quantified volume healing of the gap with new bone using threedimensional micro-CT scanning and quantified apposition and ingrowth using backscattered scanning electron microscopy. Results The density of bone inside gaps filled with demineralized bone matrix reached 64% and 93% of surrounding bone density by 4 and 12 weeks, respectively. Compared with empty controls and negative controls at 4 and 12 weeks, gap healing using demineralized bone matrix was two to three times greater and bone ingrowth and apposition were up to 15 times greater. Conclusions Demineralized bone matrix promotes rapid bone ingrowth and gap healing around porous implants. Clinical Relevance Demineralized bone matrix has potential for enhancing implant fixation in revision arthroplasty.

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Comparison of Anterior and Posterior Iliac Crest Bone Grafts in Terms of Harvest-Site Morbidity and Functional Outcomes

Cited by 571 publications

References 29 publications

Bone Graft Harvest Using a New Intramedullary System

Bone Graft Harvest Using a New Intramedullary System

Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

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