title: Substitutes of structural and non-structural autologous bone grafts in hindfoot arthrodeses and osteotomies: a systematic review.
abstract: BACKGROUND
  Structural and non-structural substitutes of autologous bone grafts are frequently used in hindfoot arthrodeses and osteotomies. However, their efficacy is unclear.The primary goal of this systematic review was to compare autologous bone grafts with structural and non-structural substitutes regarding the odds of union in hindfoot arthrodeses and osteotomies.
  
  
  METHODS
  The Medline and EMBASE and Cochrane databases were searched for relevant randomized and non-randomized prospective studies as well as retrospective comparative chart reviews.
  
  
  RESULTS
  10 studies which comprised 928 hindfoot arthrodeses and osteotomies met the inclusion criteria for this systematic review. The quality of the retrieved studies was low due to small samples sizes and confounding variables. The pooled random effect odds for union were 12.8 (95% CI 12.7 to 12.9) for structural allografts, 5.7 (95% CI 5.5 to 6.0) for cortical autologous grafts, 7.3 (95% CI 6.0 to 8.6) for cancellous allografts and 6.0 (95% CI 5.7 to 6.4) for cancellous autologous grafts. In individual studies, the odds of union in hindfoot arthrodeses achieved with cancellous autologous grafts was similar to those achieved with demineralised bone matrix or platelet derived growth factor augmented ceramic granules.
  
  
  CONCLUSIONS
  Our results suggest an equivalent incorporation of structural allografts as compared to autologous grafts in hindfoot arthrodeses and osteotomies. There is a need for prospective randomized trials to further clarify the role of substitutes of autologous bone grafts in hindfoot surgery.
authors: Orthopedic Department University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland. muelleram@uhbs.ch
authors: Marc Andreas
authors: MA
authors: Müller
authors: Alexander
authors: A
authors: Frank
authors: Matthias
authors: M
authors: Briel
authors: Victor
authors: V
authors: Valderrabano
authors: Patrick
authors: P
authors: Vavken
authors: Vahid
authors: V
authors: Entezari
authors: Arne
authors: A
authors: Mehrkens
mesh_terms: D001174:Arthrodesis / Q000009:adverse effects; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D005529:Foot Bones / Q000601:surgery*; D006801:Humans; D016017:Odds Ratio; D016348:Osseointegration; D010027:Osteotomy / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
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