Incidence of Nonunion of First Metatarsal-Phalangeal Joint Arthrodesis with Autogenous Iliac Crest Bone Graft after Failed Keller-Brandes Arthroplasty: A Systematic Review

The Keller-Brandes arthroplasty has well-documented outcomes, including many complications that culminate in arthrodesis of the first metatarsal-phalangeal joint. In the setting of a large osseous defect, the autogenous iliac crest is the most commonly referenced source for the autogenous bone graft. We undertook a systematic review of electronic databases and other relevant sources regarding the incidence of nonunion after arthrodesis of the first metatarsal-phalangeal joint using autogenous iliac crest bone graft for failed Keller-Brandes arthroplasty. Six studies involving 42 arthrodeses met our inclusion criteria. The incidence of nonunion was 4.8% (2 of 42). It has been inherently accepted that revisional surgery can increase the incidence of nonunion. Our systematic review of the available data revealed that the use of an autogenous iliac crest bone graft results in a high incidence of primary union (95.2%) for salvage arthrodesis. However, additional appropriately weighted prospective studies and comparative analyses are needed regarding this topic. (C) 2013 by the American College of Foot and Ankle Surgeons. All rights reserved.