Use of autologous bone grafting from the calcaneus and interconnected porous hydroxyapatite ceramic for bone transplantation in rheumatoid foot surgery

Abstract

Cancellous bone grafts from the calcaneus have been used for the foot and ankle as well as iliac bone graft; however, there is a sparse report for calcaneal bone transplantation in the field of rheumatoid foot surgery. In this study, safety and usefulness of calcaneal bone grafts, and combination with interconnected porous hydroxyapatite ceramic, was evaluated in rheumatoid arthritis foot surgeries. Of six rheumatoid arthritis cases, three (talo-navicular joint fusion) used a calcaneal bone graft alone, and the remaining three cases (subtalar joint and talo-navicular joint fusion) used a combination of calcaneal bone graft and interconnected porous hydroxyapatite ceramic augmented with dense calcium hydroxyapatite for subtalar bony defect (1.5–2.0 cm) after the correction. Pre- and postoperative Japanese Society for Surgery of the Foot rheumatoid arthritis foot ankle scale scores were obtained for the clinical assessment. As radiographic assessment, tibio-calcaneal angle, calcaneal pitch, talo-1st metatarsal angle, and pronated foot index were also evaluated. After starting weight-bearing or walking, there was no pain and skin trouble at the fusion and harvesting sites. All cases achieved bony fusion within 6–10 weeks. Japanese Society for Surgery of the Foot rheumatoid arthritis foot ankle score was improved in all six cases. Furthermore, tibio-calcaneal angle, talo-1st metatarsal angle, and pronated foot index were also improved at latest follow-up in all cases. In conclusion, autologous bone grafting from the calcaneus was safe and convenient even in rheumatoid foot surgeries. For larger bony defects (1.5–2.0 cm), combination use with interconnected porous hydroxyapatite ceramic augmented with dense calcium hydroxyapatite was also useful.

Evaluation of the osteoconductivity and the degradation of novel hydroxyapatite/polyurethane combined with mesoporous silica microspheres in a rabbit osteomyelitis model

“…Autologous bone, 32,33 allogeneic bone 34,35 and bioactive composite scaffold material 36 are the most commonly used materials in clinical settings for reconstructing of bone defects. Autologous bone graft is considered the gold standard for bone regeneration.…”

“…However, the clinical application of autologous bones has the following drawbacks: A limited supply of autograft material, secondary infection and donor site morbidity. 32,38 Allogeneic bone may lead to infectious diseases and immune reactions, and there are no effective treatments for it.…”

Bone Graft Harvesting From the Calcaneus Using Lateral Wall Corticotomy Technique by an Osteotome

“…3 The calcaneus is a convenient site for cancellous bone graft harvesting to fill the bony defects during the forefoot and midfoot fusions and fixation procedures. It can be used alone or in combination with the other substitutes like hydroxyapatite ceramic 8 to increase the volume of the harvested graft. Beside lack of disease transmission, bone graft from calcaneus is a simple procedure in the field of surgery without requiring preparing and draping other sites, under regional anesthesia.…”

“…4,5 Historically, ipsilateral iliac crest is the most common site of autologous bone graft harvesting 6,7 ; however, in the foot and ankle surgery field, the calcaneus is a good regional option for harvesting autologous bone graft due to the low reported morbidity rate, easy accessibility, a minimal incision, and ability to perform it with regional block anesthesia. 8-13…”

Quick Transposition of ReBOSSIS-J® to the Host Bone Trabeculae Within One Month After Supplementing to the Harvest Site on the Calcaneus for Autologous Bone Grafting in a Rheumatoid Arthritis Case

“…However, harvest sites with huge bony defects need to be filled with a bone void filler. Beta-tricalcium phosphate (β-TCP) has been reported as a useful material for filling bony defects, with material resorption and new bone formation seen three months after surgery and almost complete transposition of the harvest site to the host bone trabeculae by 12 months after surgery [ 2 ]. To further expedite rehabilitation to the point of weight-bearing or heel walking and also to prevent the fracture at the harvesting site of a calcaneal bone graft, earlier transposition to the host bone is preferable because the strength of the harvest site would then be increased or normalized earlier.…”