足と足首の臨床研究

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Revisional Hindfoot and Ankle Arthrodesis Using Recombinant Human Platelet-Derived Growth Factor and Beta-Tricalcium Phosphate

Loveland JD, Basile P, Collier BN and Manning ES

Background: The overall incidence of nonunion following primary arthrodesis in foot and ankle surgery is approximately 11%, with higher rates expected for revisional arthrodesis. Use of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) combined with beta-tricalcium phosphate (β-TCP) in primary hindfoot and ankle arthrodesis results in comparable fusion rates, less pain, and fewer side effects compared to autograft. This study evaluated the use of rhPDGF-BB/β-TCP in revisional arthrodesis in hindfoot and ankle reconstruction surgery.

Methods: The charts of patients with at least 12 months follow-up who had undergone revisional arthrodesis supplemented with rhPDGF-BB/β-TCP of the talonavicular, calcaneocuboid, subtalar, or ankle joints were retrospectively reviewed. Comorbidities included Charcot neuroarthropathy (42%), neuropathy (33%), diabetes (33%), hypertension (33%) and gastroesophageal reflux disease (8%).

Results: Twelve patients were included, of which 11 (91.7%) achieved union. The mean time to fusion was 12.9±1.9 weeks and to return to activity was 16.6±2.8 weeks. One patient developed a nonunion of the talonavicular joint. No complications related to the grafting material were observed. There were 2 infected hematomas, both of which went on to fusion.

Conclusion: Use of rhPDGF-BB/β-TCP is a viable alternative to autograft for revisional rearfoot arthrodesis, even in high-risk patients, without the pain and morbidity associated with autograft harvesting.