Keys To Optimal Selection Of Orthobiologics

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Author(s): 
Phillip E. Richardson, DPM, Brian T. Dix, DPM, Adebola T. Adeleke, DPM, John M. Baca, DPM, Robert Mendicino, DPM, FACFAS, and Alan R. Catanzariti, DPM, FACFAS

   BMP-7 has the ability to promote new blood vessel formation and has been shown to have strong osteoinductive properties. Recent level 1 studies have demonstrated promising results in the orthopedic literature. Friedlander and colleagues demonstrate that BMP-7, when mixed with a collagen carrier, was as good as autogenous graft in the treatment of tibial non-unions.36 Furthermore, BMP-7 has been FDA approved for revision arthrodesis of the lumbar spine.33

   The evidence on BMP is not all positive. Bone morphogenetic protein is a soluble substance that can diffuse away from its intended site of action and thus needs a carrier to be effective. Furthermore, BMP can cause the formation of ectopic bone, leading to painful soft tissue entrapments, and incite strong inflammatory reactions.37

   While the current evidence is good, further studies are needed to assess the morbidities associated with the recombinant bone morphogenic proteins in foot and ankle surgery.

In Summary

The skeletal system’s ability to heal itself is truly remarkable. Bone healing relies upon a complex interplay of intrinsic and extrinsic factors. These factors include a stable fixation construct, nutritional status and the presence of native growth factors and osteogenic cells. When this microenvironment is out of balance, non-union may result. Understanding the mechanisms of bone healing and the attributes of available orthobiologic substrates will give the foot and ankle surgeon the tools to enhance the musculoskeletal system’s innate ability to regenerate itself.

   Drs. Richardson, Dix, Adeleke and Baca are residents within the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh.

   Dr. Mendicino is in private practice with OhioHealth Orthopedic Surgeons in Hilliard, Ohio. He is a Fellow and Past President of the American College of Foot and Ankle Surgeons. Dr. Mendicino is board-certified in foot surgery and rearfoot and ankle surgery by the American Board of Podiatric Surgery.

   Dr. Catanzariti is the Director of the Residency Training Program within the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh. He is a Fellow of the American College of Foot and Ankle Surgeons.

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