First Metatarsophalangeal Joint Arthrodesis: Comparison of Mesenchymal Stem Cell Allograft versus Autogenous Bone Graft Fusion Rates

John Anderson, Nathan Jeppesen, Myron Hansen, Chad Brady, Adam Gough, Zflan Fowler

Alamogordo Orthopaedics, Alamogordo, USA.
Cactus Foot and Ankle, Gilbert, USA.
Gila Regional Medical Center, Silver City, USA.
Presbyterian, Albuquerque, USA.
Scripps Mercy-Kaiser Hospital, San Diego, USA.

DOI: 10.4236/ss.2013.45051                

Abstract

With patients undergoing first time 1st metatarsophalangeal joint arthrodesis using graft material when it was required to fill cystic bone voids, we retrospectively compared the time to fusion (clinical and radiographic), and non-union rate between the patient’s own bone autograft (n = 62) versus a mesenchymal stem cell impregnated allograft group (n = 51). A third control group (n = 52) was included in which an end-to-end arthrodesis was performed and no graft interposition was used or necessary. The non-union rate was 4% (n = 2) in the control group, 5.9% (n = 4) in the autograft group, and 9.5% (n = 5) in the mesenchymal stem cell allograft group. The time for radiographic fusion was 6.46 weeks for the control group, 6.52 weeks for the autograft group, and 6.53 weeks for the mesenchymal stem cell allograft group. The difference in time to clinical and radiographic union and the non-union rate were not found to be statistically significant among all 3 groups. Patient comorbidities and their possible effects on union rates were also analyzed within the populations. Some comorbidities had statistically significantly non-unions within the population, notably smoking (p = 0.024) and Rheumatoid arthritis (p = 0.001), however the populations were fairly small. The use of allogeneic bone graft impregnated with mesenchymal stem cells yields a similar fusion rate as with the use of autologous bone graft harvested from the surrounding area. The allograft impregnated with mesenchymal stem cells is a viable alternative yielding similar results when local autogenous bone graft is not available, not obtainable, or conditions warrant its use.

Keywords

Metatarsophalangeal Joint; Bone Autograft; Mesenchymal Stem Cell

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. S. Shurnas and M. J. Coughlin, “Arthritis, Postural Disorders, and Tendon disorders,” In: M. J. Coughlin, R. A. Mann and C. L. Saltzman, Eds., Surgery of the Foot and Ankle, 8th Edition, Mosby Elsevier, Philadelphia, 2007, pp. 803-922.
[2]	I. J. Alexandar, “Hallux Metatarsophalangeal Arthrodesis,” In: H. B. Kitaoka, Ed., Master Techniques in Orthopaedic Surgery: The Foot and Ankle, 2nd Edition, Lippincott Williams and Wilkins, Philadelphia, 2002, pp. 45-60.
[3]	L. S. Weil Jr., “First Metatarsophalangeal Arthrodesis,” In: T. J. Chang, Master Techniques in Podiatric Surgery: The Foot and Ankle, Lippincott Williams and Wilkins, Philadelphia, 2005, pp. 119-128.
[4]	R. A. Zambon, D. Buskirk and M. Roberts, “Osteoprogenitor Cells Preserved in the Osteocel? Tissue Product Result in Enhanced Bone Formation,” Osiris Therapeutics, Inc., Baltimore, 2005.
[5]	S. Rush, “Mesenchymal Stem Cell Allografting in Foot and Ankle Surgery,” Foot & Ankle, Vol. 3, No. 3, 2010, pp. 140-147. doi:10.1177/1938640010369638
[6]	L. Walker, A. Danilkovitch, M. L. Williams, M. Lorenz, M. R. Zindrick and R. J. Linovitz, “TrinityTM Multipotential Cellular Bone Matrix Technical Monograph,” Blackstone Medical, Inc., Baltimore, 2006.
[7]	G. M. Weinraub, J. M. Shuberth, M. Lee, S. Rush, L. Ford, J. Neufeld and J. Yu, “Isolated Medial Incisional Approach to Subtalar and Talonavicular Arthrodesis,” Journal of Foot and Ankle Surgery, Vol. 49, No. 4, 2010, pp. 326-330. doi:10.1053/j.jfas.2010.04.015
[8]	G. A. Hamilton, L. A. Ford and S. Patel, “First Metatarsophalangeal Joint Arthrodesis and Revision Arthrodesis,” Clinics in Podiatric Medicine and Surgery, Vol. 26, No. 3, 2009, pp. 459-473. doi:10.1016/j.cpm.2009.03.010
[9]	M. J. Coughlin and P. S. Shurnas, “Hallux Rigidus: Grading and Long-Term Results of Operative Treatment,” The Journal of Bone & Joint Surgery, Vol. 85, No. 11, 2003, pp. 2072-2088.
[10]	J. K. DeOrio and D. C. Farber, “Morbidity Associated with Anterior Iliac Crest Bone Grafting in Foot and Ankle Surgery,” Foot & Ankle International, Vol. 26, No. 2, 2005, pp. 147-151.
[11]	D. W. Boone, “Complications of Iliac Crest Graft and Bone Grafting Alternatives in Foot and Ankle Surgery,” Foot and Ankle Clinics, Vol. 8, No. 1, 2003, pp. 1-14. doi:10.1016/S1083-7515(02)00128-6
[12]	J. K. Ellington, C. P. Jones, B. E. Cohen, W. H. Davis, F. Nickisch and R. B. Anderson, “Review of 107 Hallux MTP Joint Arthrodesis Using Dome-Shaped Reamers and a Stainless-Steel Dorsal Plate,” Foot and Ankle Clinics, Vol. 31, No. 5, 2010, pp. 385-390, doi:10.3113/FAI.2010.0385