FOOT &ANKLE INTERNATIONAL Copyright  2006 by the American Orthopaedic Foot & Ankle Society, Inc. Bone Graft Harvest from the Proximal Tibia in Foot and Ankle Arthrodesis Surgery Michael R. Whitehouse, M.R.C.S., B.Sc.; Ben J.A. Lankester, M.A., F.R.C.S. (Tr. and Ortho.); Ian G. Winson, F.R.C.S.; Stephen Hepple, F.R.C.S., F.R.C.S. (Orth.) Bristol, United Kingdom ABSTRACT Background: Fresh autogenous cancellous bone graft is the material of choice in reconstruction and fusion procedures in foot and ankle surgery. There are many potential donor sites for graft harvest, all with recognized minor and major compli- cations. The proximal tibia is one such potential site and is particularly suited to foot and ankle surgery, because it is within the operative field and under tourniquet control. Methods: A retrospective review was performed of 148 procedures using bone graft from the proximal tibia performed over a period of 5 years. Minimum followup was 3 months. Data were obtained from operative notes and patient interviews to establish pain, morbidity, and overall satisfaction. Results: Most patients had no pain (78%) or very mild pain (20%) at the site of graft harvest immediately after surgery. At followup, 96% had no pain and 4% had very mild pain with certain activities such as kneeling. There were no major complications. Four patients (2.7%) had persisting areas of paresthesia at followup, but none were troubled by it. One patient had a superficial wound infec- tion that resolved. The period of nonweightbearing, usually 2 to 3 weeks, was dictated by the primary procedure. There were no complications related to early weightbearing Conclusions: The proximal tibia is a suitable and safe site for bone graft harvest for foot and ankle surgery. There is no need for addi- tional restrictions in weightbearing after this procedure. Key Words: Arthrodesis; Graft; Morbidity Corresponding Author: Michael R. Whitehouse, M.D. Avon Orthopaedic Center Southmead Hospital, Southmead Road Westbury-on-Trym Bristol BS10 5NB United Kingdom E-mail: mike whitehouse@yahoo.com For information on prices and availability of reprints, call 410-494-4994 X226 INTRODUCTION Autogenous cancellous bone graft remains the gold stan- dard for use in reconstruction and fusion procedures. Although there have been advances in the use of other materials, such as alloplastics, ceramics, and polymers, fresh autograft continues to demonstrate superior results over these and allografts, 4,6,7,8,11,12 with proven osteoinductive, osteo- conductive, and osteogenic capability. There is no univer- sally accepted donor site for bone graft. Possibilities include the iliac crest, ribs, distal radius, distal femur, proximal tibia, distal tibia, and calcaneus, each of which has signifi- cant minor and major complications. 1,5,14 In foot and ankle surgery, the ideal donor site is on the ipsilateral limb distal to the tourniquet (Figure 1); this site allows easy harvest and produces few postoperative mobility problems beyond those imposed by the primary procedure. In our depart- ment the proximal tibia has become the preferred site for autogenous cancellous bone harvest during foot and ankle arthrodesis procedures. Although this procedure has been reported previously, 2,3,9,13 the ability and safety of postop- erative weightbearing have not been fully investigated. The aim of this study was to perform a retrospective review of procedures involving bone graft harvest from the proximal tibia in a regional orthopaedic center to determine morbidity, complications, and acceptability to patients. MATERIALS AND METHODS A retrospective review identified 151 procedures (133 patients) between December, 1999, and January, 2005. The procedures were mainly elective arthrodesis of the hindfoot, midfoot, and ankle (Table 1). Primary and revision surg- eries were included. Data on patient demographics, date of surgery, consultant, procedure (primary or revision), donor site for bone graft, and period of limited weightbearing were obtained from patient charts and operative notes. 913 by guest on April 7, 2016 fai.sagepub.com Downloaded from