TITLE:
First Metatarsophalangeal Joint Arthrodesis: Comparison of Mesenchymal Stem Cell Allograft versus Autogenous Bone Graft Fusion Rates
AUTHORS:
John Anderson, Nathan Jeppesen, Myron Hansen, Chad Brady, Adam Gough, Zflan Fowler
KEYWORDS:
Metatarsophalangeal Joint; Bone Autograft; Mesenchymal Stem Cell
JOURNAL NAME:
Surgical Science,
Vol.4 No.5,
May
7,
2013
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.