Comparative Outcomes of Autograft vs rhPDGF-BB in Tibiotalocalcaneal, Pantalar, or Triple Arthrodesis: A Propensity-Matched TriNetX Analysis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Recent studies have suggested that recombinant human platelet-derived growth factor (rhPDGF-BB) may facilitate fusion and reduce donor-site morbidity in foot and ankle arthrodesis. However, direct large-scale comparisons between those receiving autograft and rhPDGF-BB remain limited – particularly for high-risk or revision procedures. Existing trials indicate promising outcomes in older patient populations, yet questions remain regarding efficacy, safety, and cost-benefit in broader clinical practice. To address this gap, we utilized the TriNetX research database to investigate whether rhPDGF-BB confers comparable or superior fusion outcomes and complication profiles compared to autografts. Methods: The TriNetX database was queried using CPT and ICD codes to identify patients undergoing tibiotalocalcaneal (TTC), pantalar, or triple arthrodesis from 2003 to 2023, with a minimum of one-year follow-up. Patients were divided into autograft and rhPDGF-BB cohorts. Demographics, comorbidities, and Charlson Comorbidity Index (CCI) scores were collected. Total complication rates within one-year post-op, including prosthetic joint infections, surgical site infections, superficial skin infections, infection-related return to operating room, wound disruption, osteolysis, nonunion, and hardware removal, were also collected. A 1:1 propensity score matched analysis was performed based on age, sex, body mass index (BMI), nicotine dependence, and select comorbidities. Statistical analyses were conducted on TriNetX using Z-tests for pairwise comparisons, with significance set at p< 0.05. All results are shown in Table 1. Results: A total of 172 patients in the rhPDGF-BB cohort and 6,741 in the autograft cohort were identified. The rhPDGF-BB cohort was older (59.6 vs. 56.8 years, p = 0.012) and had higher rates of diabetes (34.9% vs. 27.1%, p = 0.023), HIV (16.3% vs. 11.0%, p = 0.030), and several comorbidities, including chronic lower respiratory disease, liver disease, dementia, peptic ulcers, nicotine dependence, malignancy, myocardial infarction, and stroke (all p < 0.05). After propensity matching (n = 172 per cohort), the rhPDGF-BB cohort had a lower nonunion rate (OR 0.354, 95% CI 0.165-0.760, p = 0.006) with no other significant outcome differences (Table 2). Conclusion: Our propensity-matched analysis supports the growing evidence favoring rhPDGF-BB as an effective alternative to autograft, demonstrating a significantly lower nonunion rate without increased complications. These findings underscore the potential for rhPDGF-BB to address high-risk scenarios while mitigating morbidity associated with autograft harvest. Future prospective, randomized studies are warranted to validate these outcomes, elucidate long-term cost-effectiveness, and optimize patient selection. Overall, our results highlight the value of biologic adjuncts in advancing care for complex hindfoot and ankle arthrodeses, offering clinicians additional tools for improving fusion rates and reducing procedural morbidity.