SLR - September 2022 - Hector Santiago, DPM
Reference: Lukasiewicz AM, Bagi PS, Yu KE, Tyagi V, Walls RJ. Novel Vacuum-Assisted Method for Harvesting Autologous Cancellous Bone Graft and Bone Marrow From the Proximal Tibial Metaphysis. Foot Ankle Orthop. 2021 Jan 25;6(1):2473011420981901Level of Evidence: Level IV, Retrospective case series
Reviewed by: Hector Santiago, DPM
Residency Program: Bethesda East- Boynton Beach, FL
Podiatric Relevance: Utilizing a novel vacuum-assisted bone harvesting device to acquire cancellous bone and marrow from the proximal tibia to aid with enhancing the fusion potential of lower extremity fusion sites
Methods: Ten patients who underwent foot/ankle complex primary arthrodesis at a single tertiary academic center using proximal tibia autograft obtained using a vacuum-assisted bone harvesting device were identified. One patient was excluded due to a lack of follow-up for a total of 9 patients enrolled. Three patients underwent primary tibiotalocalcaneal arthodesis, one underwent primary tibiotalar arthrodesis, one underwent primary subtalar arthrodesis, and the remainder underwent various revision arthrodeses. All patients had no history of knee pain, knee injury, or surgery at the proximal tibia. All patients were evaluated at 2 and 6 weeks postoperatively evaluating for donor site pain/complications. Descriptive statistics were used to summarize patient and operative characteristics and outcomes.
Results: On average, 27 mL of solid graft and 16 mL of liquid phase aspirate were collected. At 6 weeks after the procedure, there was minimal to no pain at the donor site. Zero fractures or complications were observed in this study when the donor site was backfilled with a bone substitute. One-year post-operative follow up was conducted and there were no patients with a proximal tibial fracture after the proximal tibial bone harvest was performed. With the added benefit of autologous marrow for insertion into the fusion site may confer increased success by enhancing the osteoinductive and osteogenic load thus enhancing the fusion potential of the fusion site. Although proximal tibial fracture has been reported in the literature, this is a rare complication, occurring in less than 1 percent of patients. This has been avoided by backfilling the grafted void site.
Conclusion: The study showed great success and patient satisfaction when a vacuum assisted bone harvester was utilized to aid with their foot and ankle fusion surgery. Patients had minimal pain as well as no fractures noted to the proximal tibial harvest site when evaluated at 2 and 6 weeks post operatively. A strength of the study is the fact that it was performed by the same surgeon as well as the follow up time with the patients. While a limitation is the small sample size. A more in-depth and deeper review should be conducted focusing on other factors of the vacuum assisted bone harvester, such as a study to compare rates of union vs nonunion. One can also investigate further if this technique speeds up the recovery time to weight bear. Authors of this study recommend the Vacuum Assisted Bone Harvester due to patient satisfaction, minimal chance of complications to donor site, no tibial fractures as well as enhancing fusion site potential due to autologous bone graft.