THE USE OF RECOMBINANT HUMAN BMP7 IN LIMB RECONSTRUCTION SURGERY – AN AUDIT

Abstract

Human recombinant Osteogenic Protein 1 or rhBMP-7 is licensed for use in tibial non-union where autologous bone grafting has failed. Through its osteoconductive and osteoinductive properties, its application may be more widely applied. We audited our use of rhBMP-7 and present the largest series currently reported in the literature.

We reviewed 107 consecutive patients on whom rhBMP-7 was used over a 5-year period (2002–2007). Demographic and clinical details (e.g indication, site, use of adjuncts, previous surgery, smoking status, time to union, mean follow up etc) were entered into an electronic spreadsheet.

RhBMP-7 was used in 112 sites on 107 patients (65 male, 42 female). Ages ranged from 16yrs to 89yrs (mean 47.6). Non-union was the main indication for surgery (82 cases). RhBMP-7 was used alone in 39 cases and with autologous bone graft (56 cases). In other cases demineralised bone matrix, USS and bone allograft were used as adjuncts. Tibia (42 cases), femur (29 cases), humerus (21 cases) were the most common sites of administration. Mean number of operations prior to use of rhBMP-7 was 1.6 (range 1–20). In all cases, union was achieved in 65% (73/112) with a mean union time 5.8 months. The ‘rhBMP-7 alone’ subgroup demonstrated union in 83% (30/36), mean union time 5.15 months. 68% (56/82) of cases treated for nonunion subsequently united with rhBMP-7.

Our results suggest rhBMP-7 is useful in the management of fracture non-union and limb reconstruction surgery irrespective of site. It promotes bone healing of non-unions subjected to multiple operations previously. It may be indicated in those patients in whom autologous bone graft harvest is undesirable or not possible or as an adjunct to bone grafting. Moreover we did not detect any adverse reactions specific to the administration of rhBMP-7.