Impact of Bone Graft on Fusion Rates in Primary Open Ankle Arthrodesis Fixated With Cannulated Screws: A Systematic Review

Abstract

There is currently no consensus on the importance of bone graft use in ankle arthrodesis. Despite this, bone graft is widely used. We aimed to summarize the available literature on primary open ankle arthrodesis fixated with cannulated screws in order to assess the importance of bone graft in achieving more favorable rates of fusion. PubMed and Embase were queried for articles reporting on primary open ankle arthrodesis fixated with cannulated screws which specified use or non-use of bone graft. Pooled data analysis was performed. Modified Coleman Methodology Scores were calculated to assess reporting quality. Twenty-seven studies met our inclusion criteria and were divided into three groups: no bone graft (NBG), fibular onlay with bone graft (FOBG), and use of bone graft (BG). All three groups had comparable fusion rates of 94.7%, 95.3%, and 95.1% respectively (p = .98). Number needed to treat was 7 and Absolute Risk Reduction was 14.8%. The reviewed literature was largely of moderate quality, with an overall Coleman score of 60.6 and no significance between the 3 groups (p = .93). In conclusion, primary open ankle arthrodesis fixated with cannulated screws generally had favorable fusion rates, and bone graft use did not have a significant effect on union rates. The available literature suggests that bone graft may not be needed in routine tibiotalar arthrodesis in low-risk patients. It may more significantly impact patients who are at high-risk of fusion failure, and dedicated research on this high-risk subset of patients is required.

Keywords: ankle fusion; ankle fusion bone graft; tibiotalar arthrodesis; tibiotalar bone graft; tibiotalar fusion.