The Efficiency of Highly Porous β-Tricalcium Phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in Midfoot Joint Arthrodesis

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in midfoot joint arthrodesis. Methods: This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws from January 2014 to May 2019. A total of 44 patients (46 feet) including 89 joints were included in this study. The cohort was then stratified into two groups: 25 patients (26 feet) in arthrodesis with highly porous β-TCP and BMAC (group A) and 19 patients (20 feet) in arthrodesis without highly porous β-TCP and BMAC (group B). The osseous union rate was compared between the two groups. Demographic and operative data including age, sex, body mass index (BMI), smoking, etiology of arthritis, comorbidities such as diabetes mellitus and rheumatoid arthritis, number of joints fixed, use of bone graft or bone substitute, and postoperative midfoot anatomic alignment in the two groups were compared. Results: There was a significant difference in the union rate between the two groups: 91.5 % (43 out of 47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2 % (32 out of 42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B) (P = 0.048). During the follow-up period, a total of four postoperative complications were reported in this study. In group A, two patients developed hardware irritation, and all of them underwent removal of hardware procedure. In group B, one patient had a superficial wound infection, which was resolved completely without further treatment. The other patient in group B developed a deep wound infection with dehiscence, and it was managed with irrigation and debridement followed by vacuum assisted wound closure therapy. Conclusion: This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC compared to arthrodesis without them, suggesting that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis.