Recombinant human platelet-derived growth factor-BB versus autologous bone graft in foot and ankle fusion: A systematic review and meta-analysis

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Highlights

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    We analyzed outcomes of radiologic effectiveness, clinical results, and safety results between the two groups.

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    Results of analysis showed that rhPDGF-BB was as effective and safe as ABG in ankle and fusion.

Abstract

Today, autogenous bone graft (ABG) is still considered as the gold standard for joint fusion. Recombinant human platelet-derived growth factor-BB (rhPDGF-BB) which is of chemotactic and mitogenic to mesenchymal stem cells and possesses outstanding osteogenetic potentials has been used for ankle and foot fusion in recent years. The goal of this article is to evaluate the safety and efficacy of rhPDGF-BB versus ABG in foot and ankle fusion. The PubMed MEDLINE, EMBASE, Web of Science, and Cochrane Library were systematic searched. Finally, three randomized controlled trials (RCTs) with 634 patients were enrolled in this study. Results of radiologic effectiveness which included CT and radiographic union rates revealed that there was no significant difference between rhPDGF-BB approach and ABG approach. Analysis of clinical results held the same outcomes expect that ABG group was superior in long-term Short Form-12 physical component scores. The pooled results also demonstrated that rhPDGF-BB was as safe as ABG in foot and ankle surgery. However, autograft harvesting procedure has some drawbacks such as donor-site pain and morbidity, additional operation time, blood loss, and scarring, which can be overcome by rhPDGF-BB. Thus, rhPDGF-BB is a viable alternative to autograft in foot and ankle fusion surgery. Yet, more high-quality RCTs with long-term follow-up are still required to make the final conclusion.

Section snippets

Background

The arthritis of ankle and foot joints usually result in pain, deformity and functional limitation, which significantly influence quality of life [1]. Today, arthrodesis is still a common and reliable surgical treatment option for end-stage of ankle and foot arthritis. However, the ankle and foot joints bear the highest loads per square centimeter in whole body [2], which makes them prone for complications when fused. One of the most common complications is nonunion. As the nonunion rate of

Search strategy and study selection

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines [19] and the recommendations of Cochrane Collaboration [20] were followed to carry out this meta-analysis. The PubMed MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched for randomized controlled trials published up to July 2015. Key terms used for database research were: autologous bone graft, platelet derived growth factor, ankle, foot, fusion, and arthrodesis. Boolean operators of

Search results

461 studies were found through the primary search. Then, 35 studies were assessed for eligibility and full-text read after excluding duplicate and irrelevant studies. Among them, the following 32 studies were excluded: 3 basic researches, 9 review articles, 7 studies in which the grafts were not applied in foot or ankle fusion, and 13 studies that did not include comparison between rhPDGF-BB and ABG. Finally, 3 prospective RCTs studies were finally enrolled in our study [16], [17], [18] (Fig. 1

Discussion

To mitigate the risk of nonunion, ABGs are often used to conduct and induct bone formation. These autografts are usually harvested from iliac crest, proximal tibia, and calcaneus [24], [25], [26]. Despite being considered to be the most effective enhancer for bone healing, ABG harvest will take additional operation time, supply, and medications. Besides donor-site morbidity, the graft harvest will result in some donor-site complications as persistent pain, seroma formation, fracture, infection,

Limitation

This study had some limitations. There were only 3 RCTs with 634 patients met enrollment criteria for this meta-analysis so that publication bias couldn’t be revealed in this study. Two studies were from the same group, so only two different teams were really included. The quality of enrolled studies was not very high either. Some results of pooled estimate also revealed clinical heterogeneity. As a result, reliability of some important results might be influenced. Overall, more randomized

Conclusion

RhPDGF-BB and ABG share comparable radiologic and clinical results in foot and ankle fusion. Surgery done with rhPDGF-BB has proved to be safe enough as well. Utilization of this growth factor can also eliminate the complications associated with the autograft harvesting procedure such as donor-site pain and morbidity, additional operation time, blood loss, and scarring. As a result, rhPDGF-BB is considered to be a good choice for foot and ankle fusion. However, more high-quality RCTs with

Conflict of interest

The authors declared no conflicts of interest.

Acknowledgments

This work was supported by grants from Jiangsu Provincial Special Program of Medical Science (BL2012004), Jiangsu Provincial Clinical Orthopedic Center, and The Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).

References (46)

  • J.A. Goulet et al.

    Autogenous iliac crest bone graft. Complications and functional assessment

    Clin Orthop Relat Res

    (1997)
  • L.B. Chou et al.

    Stress fracture as a complication of autogenous bone graft harvest from the distal tibia

    Foot Ankle Int

    (2007)
  • V. Khoshkam et al.

    Outcomes of regenerative treatment with rhPDGF-BB and rhFGF-2 for periodontal intra-bony defects: a systematic review and meta-analysis

    J Clin Periodontol

    (2015)
  • J. Fiedler et al.

    To go or not to go: migration of human mesenchymal progenitor cells stimulated by isoforms of PDGF

    J Cell Biochem

    (2004)
  • A.I. Caplan et al.

    PDGF in bone formation and regeneration: new insights into a novel mechanism involving MSCs

    J Orthop Res

    (2011)
  • J.O. Hollinger et al.

    Accelerated fracture healing in the geriatric, osteoporotic rat with recombinant human platelet-derived growth factor-BB and an injectable beta-tricalcium phosphate/collagen matrix

    J Orthop Res

    (2008)
  • L.A. Solchaga et al.

    Safety of recombinant human platelet-derived growth factor-BB in Augment((R)) Bone Graft

    J Tissue Eng

    (2012)
  • T.R. Daniels et al.

    Prospective randomized controlled trial of hindfoot and ankle fusions treated with rhPDGF-BB in combination with a beta-TCP-collagen matrix

    Foot Ankle Int

    (2015)
  • C.W. Digiovanni et al.

    Prospective, randomized, multi-center feasibility trial of rhPDGF-BB versus autologous bone graft in a foot and ankle fusion model

    Foot Ankle Int

    (2011)
  • C.W. DiGiovanni et al.

    Recombinant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/b-TCP): an alternative to autogenous bone graft

    J Bone Joint Surg Am

    (2013)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    BMJ

    (2009)
  • L. Bero et al.

    The Cochrane Collaboration preparing, maintaining, and disseminating systematic reviews of the effects of health care

    Jama

    (1995)
  • Higgins JPT, S.G. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration....

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    Han Sun and Pei-Pei Lu contributed equally to this work.

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