Subtalar Distraction Arthrodesis Using Fresh-Frozen Allogeneic Femoral Head Augmented With Local Autograft

Abstract

This study found that SDA using fresh-frozen femoral head allograft without an orthobiological agent was cost-effective and may have outcomes comparable to those using autograft or allograft enriched with orthobiological agents.

Systematic Review of Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis

“…Tricortical autologous iliac crest bone graft is the most common graft used in SDA. Other graft types used include local autograft from the lateral calcaneal wall exostectomy, 2,12,17,27,29 femoral head allograft, 10,18,22,24,32 iliac crest allograft, 22,27 freeze-dried bovine xenograft, 19 and porous tantalum. 26 Most commonly described is a trapezoid or wedge-shaped bone block with the graft tallest medially and posteriorly (laterally and anteriorly tapered) 3,9,18,25 to prevent the complication of varus malpositioning.…”

“…22 Chiang et al also recently reported a 100% union rate with the use of femoral head allograft without orthobiologic agents, although they did augment with local autograft from the lateral calcaneal wall. 10 In 2016, Monaco et al 24 reported 100% union rate with the use of fresh-frozen femoral neck allograft without any adjuvant modalities. 24 The trend toward allograft avoids the harvest site morbidity that is reported, including persistence of donor site pain.…”

“…12,15,18,19,32 In addition, Easley et al reported 3 of 5 patients with allograft progressed to nonunion. 15 More recent studies have found that allograft had equivalent § § References 3,6,7,10,11,18,19,26,27,30,32. ¶ ¶ References 2,3,6,[9][10][11]18,19,24,26,27,30,32.…”

“…Data from all 25 studies were included in the demographic and statistical analyses for a total of 492 subtalar distraction arthrodesis in 467 patients. [2][3][4][5][6][7][8][9][10][11][14][15][16][17][18][19][22][23][24][25][26][27][28][29][30]32…”

“…However, more recent authors argue against the use of orthobiologic agents after obtaining cost-effective and comparable outcomes without augmentation. 10 A more cost-effective augmentation technique may be using local cancellous autograft for the biologic component.…”