Recombinant human BMP-2 increases the incidence and rate of healing in complex ankle arthrodesis. Academic Article uri icon

Overview

MeSH

  • Adult
  • Aged
  • Aged, 80 and over
  • External Fixators
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Recombinant Proteins
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult

MeSH Major

  • Ankle Injuries
  • Ankle Joint
  • Arthrodesis
  • Bone Morphogenetic Protein 2
  • Fracture Healing
  • Osteogenesis

abstract

  • Although its FDA-approved applications are limited, the pro-osteogenic benefits of recombinant human BMP-2 (rhBMP-2) administration have been shown in off-label surgical applications. However, the effects of rhBMP-2 on ankle fusions are insufficiently addressed in the literature, which fails to include a case-control study of adequate sample size to evaluate the efficacy of rhBMP-2 treatment. In this study we asked whether rhBMP-2 treatment (1) would increase the rate of successful ankle fusion in complex patients (patients with comorbidities associated with poor surgical healing) compared with a control group of patients undergoing ankle fusion who did not receive rhBMP-2; (2) would reduce total time wearing a frame when compared with the control group; (3) would result in a difference in the percentage of bone bridging between the group treated with rhBMP-2 and the control group, as determined by CT scans 3 months after surgery; and (4) would encounter an equal rate of complications different from untreated patients. A retrospective chart study was performed on 82 patients who, because of a host of comorbidities associated with poor healing, required a complex ankle arthrodesis with the Ilizarov technique. The first 40 patients did not receive rhBMP-2, whereas the subsequent 42 patients received intraoperative rhBMP-2. Time wearing the frame was determined by chart review; decision to remove the frame was made by the surgeon based on quantitative bone bridging measured using a CT scan taken 3 months after fusion. Patients treated with rhBMP-2 were more likely to obtain fusion after the initial surgery (93% versus 53%, p < 0.001; OR, 11.76; 95% CI, 3.12-44.41), spent less total time wearing the frame (124 versus 161 days, p < 0.01), and showed more bone bridging on CT scans (48% versus 32%, p < 0.05). All patients with greater than 30% bone bridging observed on CT scans 3 months postoperatively achieved successful union without further intervention. Our findings suggest that rhBMP-2 is a beneficial adjunct for selected groups of patients undergoing complex ankle arthrodesis. CT is a promising modality in the assessment of bone healing in ankle fusion. A proper randomized controlled trial remains necessary to fully describe the efficacy of rhBMP-2 in accelerating bone healing.

publication date

  • February 2014

has subject area

  • Adult
  • Aged
  • Aged, 80 and over
  • Ankle Injuries
  • Ankle Joint
  • Arthrodesis
  • Bone Morphogenetic Protein 2
  • External Fixators
  • Female
  • Fracture Healing
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Osteogenesis
  • Recombinant Proteins
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult

Research

keywords

  • Journal Article

Identity

Language

  • eng

PubMed Central ID

  • PMC3890193

Digital Object Identifier (DOI)

  • 10.1007/s11999-013-3261-7

PubMed ID

  • 23990449

Additional Document Info

start page

  • 732

end page

  • 739

volume

  • 472

number

  • 2