Orthobiologics in Foot and Ankle Arthrodesis: A Systematic Review

Nancy Greer, Patrick Yoon, Brittany Majeski, Timothy J. Wilt

Research output: Contribution to journalArticle


Orthobiologics are biologically-derived materials intended to promote bone formation and union. We review evidence on effectiveness and harms of orthobiologics compared to no orthobiologics for foot and ankle arthrodesis. We searched multiple databases (1995-2019) and included clinical trials and other studies with concurrent controls, English language, and reporting patient-centered outcomes, union/time to union, costs/resource utilization, or harms. Studies were organized by orthobiologic used. We describe quality and limitations of available evidence but did not formally rate risk of bias or certainty of evidence. Most of the 21 studies included were retrospective chart reviews with orthobiologics used at surgeon's discretion for patients considered at higher risk for nonunion. Ten studies compared autologous bone graft versus no graft and 2 compared remote versus local graft with few studies of other orthobiologics. All studies reported a measure of fusion and about half reported on function/quality of life. Few studies reported harms. Due to limited reporting, we were unable to assess whether effectiveness varies by risk factors for nonunion (eg, age, gender, smoking status, obesity, diabetes) or whether orthobiologics were cost-effective. Available evidence is of poor quality with small sample sizes, inadequate reporting of risk factors for nonunion, variations in orthobiologics, surgical techniques used, and outcome assessment, and potential selection bias. Research is needed to adequately inform surgeons about benefits and harms and guide patient selection for use, or type, of orthobiologics. Careful assessment of individual patient risk for nonunion is critical prior to orthobiologic use.

Original languageEnglish (US)
Pages (from-to)1029-1037
Number of pages9
JournalJournal of Foot and Ankle Surgery
Issue number5
Early online dateApr 20 2021
StatePublished - May 28 2021

Bibliographical note

Funding Information:
Financial Disclosure: The development of the ESP review on which this manuscript is based was funded by Department of Veterans Affairs , Veterans Health Administration , Health Services Research and Development . The funding source reviewed the protocol for the review but was not involved in data collection, analysis, manuscript preparation, or submission.

Publisher Copyright:
© 2021


  • 2
  • autograft
  • fusion
  • harms
  • quality of life
  • resource utilization

PubMed: MeSH publication types

  • Journal Article
  • Review
  • Systematic Review


Dive into the research topics of 'Orthobiologics in Foot and Ankle Arthrodesis: A Systematic Review'. Together they form a unique fingerprint.

Cite this