Use of demineralized bone matrix in hindfoot arthrodesis

Fifty-five patients considering a hindfoot fusion performed by the senior author over a 5-year period were given the choice of having the fusion augmented by either iliac crest bone graft or demineralized bone graft in a study of the relative efficacy of these 2 methods of bone grafting. Eleven patients underwent subtalar fusion (average age, 40.1 +/- 14.0 years), and 44 had a triple arthrodesis (average age, 54.6 +/- 19.2 years). The most common indications for surgery were posterior tibial tendon insufficiency and traumatic arthritis. There were no significant differences between groups regarding underlying disease, medications, or associated medical conditions. In isolated subtalar fusions, all 3 patients who received an iliac crest bone graft experienced healing, as did 7 of 8 patients who received demineralized bone graft. The eighth patient had a radiographic non-union without clinical symptoms. Complete healing of triple arthrodeses was achieved in 13 of 15 patients who received an iliac crest bone graft and in 29 of 29 patients receiving a demineralized bone graft. There were no intergroup differences in the time to union, which generally was between 3 and 4 months. Intraoperative blood loss was significantly less with demineralized bone graft (33 +/- 25 ml) than with iliac crest bone graft (206 +/- 192 ml). This study demonstrated that demineralized bone graft aids arthrodesis at least as well as does iliac crest bone graft, without the increased blood loss, cost, and postoperative pain associated with iliac crest bone harvest.