title: The effect of recombinant bone morphogenetic protein-2 in revision tibiotalocalcaneal arthrodesis: utilization of the Retrograde Arthrodesis Intramedullary Nail database.
abstract: The use of bone morphogenetic protein-2 (BMP-2) has been recommended for high-risk fusions and nonunion. Patients undergoing revisional tibiotalocalcaneal (TTC) arthrodesis via a retrograde arthrodesis nail to evaluate the influence of BMP-2 on rate of fusion in this high-risk population are presented. A retrospective chart and radiographic review were performed on 23 patients with failed prior fusion attempts at the ankle treated with retrograde intramedullary nailing. Sixteen patients were treated without BMP-2 (None group) and 7 were treated with BMP-2 (BMP group). The primary and secondary end-points were successful fusion, and time to fusion, respectively, with a variety of variables evaluated for influence. Other than the use of BMP-2, there were no statistical differences in the patient population. Overall, 11 of 16 ankles (68.8%) in the None group and 5 of 7 ankles (71.4%) in the BMP group resulted in a stable, functional limb. Rate of complication was similar between the 2 groups (p > .05). Time to radiographic ankle union was 115.2 and 184.0 days in the None and BMP groups (p > .05). The effect of BMP-2 on revisional TTC fusions with retrograde nails is reported here. The overall result as a stable, functional limb was 69.6%, which suggests that revision surgery in this high-risk population is a reasonable consideration. Even though this study was unable to demonstrate statistically significant differences, biologic augmentation with BMP-2 did not increase the complication rate and showed a slightly enhanced salvage rate for revision TTC fusions with an intramedullary nail.
authors.affiliation: Ripon Medical Center, Ripon, WI, USA.
authors.forename: J George
authors.initials: JG
authors.lastname: DeVries
authors.forename: Minh
authors.initials: M
authors.lastname: Nguyen
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Berlet
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Hyer
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery*; D016267:External Fixators; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013628:Talus / Q000601:surgery*; D013977:Tibia / Q000601:surgery*
chemical_list: D055396:Bone Morphogenetic Protein 2