Pain and Complications Following Bone Marrow Aspirate Concentrate Harvested From the Iliac Crest in Foot and Ankle Surgery

Abstract

Background Autologous bone graft is the gold standard in orthopedics, with the iliac crest the most common harvest site. In an attempt to minimize morbidity with open bone graft harvest from the iliac crest and still maintain the benefit of collecting and transplanting live cells and growth factors, bone marrow aspirate concentrate (BMAC) from the iliac crest has become increasingly popular. However, any harvest procedure can potentially cause pain and complications. The purpose of this study was to evaluate the safety and complications of BMAC from the iliac crest for use in foot and ankle fusion procedures. Methods A retrospective chart review was performed on all patients who underwent BMAC harvest from the iliac crest with their foot or ankle procedure by 1 of 4 fellowship-trained surgeons (2014-2017) with a minimum of 6-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the harvest. The final outcome follow-up was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31-81 years) and 69% were women. Results Out of 55 patients, 52 (94.5%) reported good to excellent results, and satisfaction with the procedure at the time of the questionnaire. Three patients reported persistent complications and some element of dissatisfaction after 6 months. Some patients reported transient complications (hematomas and numbness) that eventually resolved. Fifty percent of patients reported some element of immediate post-operative pain. However, at the time of final follow-up, only 2 reported persistent pain at the harvest site lasting up to 6 months, but it was not activity limiting. Conclusion BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity. Levels of Evidence Level IV: Case series

Contemporary Review: Autograft Bone Use in Foot and Ankle Surgery

“… 2 , 5 , 8 , 10 Other reported complications include infection, persistent numbness, hematoma, fracture, lateral femoral cutaneous nerve injury, and hernia. 2 , 5 , 7 , 25 …”

“… 17 , 18 , 25 The combination of these properties and benefits makes autografts an attractive option for adjunctive use in procedures like arthrodesis, with the goal of enhanced bone healing and, therefore, successful fusion. 7 , 28 Associated donor site morbidity, however, remains the main potential downside to autograft harvest. 5 , 7 , 10 , 17 , 20 …”

“… 7 , 28 Associated donor site morbidity, however, remains the main potential downside to autograft harvest. 5 , 7 , 10 , 17 , 20 …”

“… 3 , 18 However, iliac crest donor site morbidity and complications remain a concern, with frequent donor site pain and a reported complication rate as high as 49%. 2 , 5 , 7 , 10 , 18 , 25 Foot and ankle surgeons have therefore explored the ipsilateral tibia and calcaneus as alternative harvest sites because of their accessibility and potentially lower morbidity. 7 , 12 , 13 , 18 , 32 …”

“… 2 , 5 , 7 , 10 , 18 , 25 Foot and ankle surgeons have therefore explored the ipsilateral tibia and calcaneus as alternative harvest sites because of their accessibility and potentially lower morbidity. 7 , 12 , 13 , 18 , 32 …”