Bone Graft Substitutes Used in Non-spinal Orthopaedic Arthrodesis Surgery: A Systematic Review

Bone graft is commonly used to promote joint arthrodesis. Currently, the bone graft options used surgically include autograft, allograft, and bone graft substitutes (BGS). Limited availability, potential morbidity (associated with autograft harvest), efficacy concerns, costs, and the theoretical risk of disease transmission have led to an increased use of BGS. Although there are numerous BGS available, it remains unclear which BGS provide the best clinical outcomes. This systematic review is intended to evaluate the quantity and quality of published BGS clinical outcome studies in non-spinal orthopaedic arthrodesis surgery. A comprehensive literature search of PubMed, Embase, and the Cochrane Library identified 1,751 studies of which 15 met inclusion criteria. All of these studies were of the foot and ankle and represented eight commercially available BGS. Among them, Augment had the most evidence and received a grade A recommendation. All other BGS received grade I recommendations due to insufficient published clinical outcome data. These findings highlight the limited published evidence on the clinical outcomes associated with the use of BGS in non-spinal orthopaedic arthrodesis surgery. Surgeons should continue to use the best available evidence when selecting BGS while recognizing the need for additional high-quality clinical studies.