Comparison of the efficacy of bone substitutes versus autografts in aseptic non-union of the tibia. Retrospective study of 60 patients

Rares Bredicianu; Thierry Judet; Romulus Fabian Tatu; Fabrice Gaudot

doi:10.1016/j.otsr.2025.104574

Comparison of the efficacy of bone substitutes versus autografts in aseptic non-union of the tibia. Retrospective study of 60 patients

Orthop Traumatol Surg Res. 2025 Dec 20:104574. doi: 10.1016/j.otsr.2025.104574. Online ahead of print.

Authors

Rares Bredicianu¹, Thierry Judet², Romulus Fabian Tatu³, Fabrice Gaudot⁴

Affiliations

¹ Centre Hospitalier de Sarrebourg, 25, Avenue General-de-Gaulle, 57400 Sarrebourg, France. Electronic address: r.bredicianu@ch-sarrebourg.fr.
² Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
³ Orthopedics Traumatolology III Departement, University of Médecine and Pharmacy Victor Babes, Timisoara, Romania.
⁴ Service de Chirurgie Orthopédique, Ramsay Santé, Clinique Jouvenet, 6 Square Jouvenet, 75016 Paris, France.

PMID: 41429273
DOI: 10.1016/j.otsr.2025.104574

Abstract

Background: Reconstruction of segmental bone loss of the limbs is a surgical challenge, particularly regarding the reconstruction strategy and choice of bone graft. Several bone reconstruction techniques have been validated, but the gold standard remains bone autograft. However, in certain situations, the availability or volume of bone autograft may be insufficient. The use of bone substitutes as a replacement is debated in the treatment of segmental non-union of the tibia, and little is known about bone substitute in such circumstances. Therefore we performed a retrospective study aiming: 1) to determine whether the use of bone substitutes achieves the same rate of consolidation as the use of autografts in surgical treatment of segmental non-union of the tibia, 2) to determine differences in time to consolidation and in the occurrence of complications.

Hypothesis: The consolidation rate of bone substitute reconstruction is equivalent to that of autograft reconstruction.

Material and methods: Sixty patients operated for aseptic non-union of the tibia with segmental bone loss were analyzed. Forty-three were reconstructed with bone autograft (group A) and 17 with calcium triphosphate hydroxyapatite biphasic ceramic substitute (SCBHTC) (group S). Consolidation was assessed clinically and radiologically, with a minimum follow-up of 2 years. Segmental bone loss averaged 3.36 ± 1.3 cm in group A, and 3.64 ± 1.7 cm in group S (NS).

Results: After an average follow-up of 27 months, consolidation was achieved in 91% (n = 39/43) in group (91%) and 88% in group S (n = 15/17) (p = 0.08), with an average delay of 142 ± 64 days in group A and 189 ± 114 days in group S (p < 0.01). There were 5/43 (11.6%) iterative surgeries in group A versus 4/17 (23.5%) in group S (p < 0.05).

Discussion: SCBHTC reconstructions of tibia bone loss appear to achieve the same bone consolidation rates as autograft techniques in segmental non-union tibia, with no risk of complication. However, autograft reconstructions achieved significantly faster consolidation than those using substitutes. The use of SCBHTC could be considered in reconstructions of segmental non-union tibia, as a second-line treatment in cases when bone autograft use is not possible.

Level of evidence: III; retrospective case control.

Keywords: Aseptic non union; Autograft reconstruction; Induced membrane technique alternative; Osteoperiosteal decortication; Tibial shaft fractures.