title: Bovine xenograft failures in pediatric foot reconstructive surgery.
abstract: BACKGROUND
  Structural bone grafting serves an important and necessary role during pediatric foot reconstruction. Different bone grafts have been used for such reconstructions including corticocancellous autografts, allografts, and synthetic grafts. Bovine xenografts represent a novel option with multiple potential advantages; however, there are limited clinical data on the efficacy and success of such grafts. This retrospective case series was performed to review the anecdotally recognized high failure rate of bovine xenograft transplantation in pediatric foot reconstruction at a tertiary institution.
  
  
  METHODS
  Ten pediatric patients with 13 feet underwent reconstructive procedures involving implantation of bovine xenografts for various foot deformities. The mean age at time of surgery was 14.1 years with an average clinical follow-up of 21.6 months. All patients received lateral column lengthening with additional various other reconstructive procedures performed by 3 separate orthopaedic surgeons in a similar step-wise manner. Clinical outcomes were obtained through a retrospective chart review of standard preoperative and postoperative clinical and radiographic data.
  
  
  RESULTS
  Seven of 13 (53.8%) bovine xenografts implanted resulted in clinical symptoms of failure with corresponding radiographic failed graft incorporation. The most common presenting symptom was foot pain with activity and each failure was easily identified on plain radiographs by lucency surrounding the graft sites. All 7 failures required a subsequent revision surgery to remove the bovine graft followed by placement of human iliac crest allograft. After revision surgery, each patient reported subjective improvement in pain and return to daily activity with radiographic evidence of complete incorporation of the graft.
  
  
  CONCLUSIONS
  Bovine xenografts used as structural grafts in pediatric foot reconstruction resulted in unacceptably high rates of failure and the need for further revision surgery. For this reason, surgeons should be cautioned against the use of bovine xenograft material in the surgical management of pediatric foot deformity.
  
  
  METHODS
  Level IV case series.
authors: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. cameron.ledford@duke.edu
authors: Cameron K
authors: CK
authors: Ledford
authors: James A
authors: JA
authors: Nunley
authors: Nicholas A
authors: NA
authors: Viens
authors: Robert K
authors: RK
authors: Lark
mesh_terms: D000293:Adolescent; D000818:Animals; D016025:Bone Transplantation / Q000379:methods*; D002417:Cattle; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005530:Foot Deformities / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome