Abstract
Statement of purpose
To determine the outcome of the use of Bone Morphogenetic Protein 7 (BMP7) as a replacement for bone graft in a limb reconstruction unit
Methods
Retrospective case note and imaging review was performed on a cohort of 71 consecutive patients from October 2009 to October 2012 in whom BMP7 was used to achieve union. The patients were identified from a pharmacy database. Factors analysed included the perceived indication, location in the skeleton, age, comorbidities, type of procedure (non-union, fusion, docking site etc), complications and need for revision surgery.
Results
BMP7 was used in 71 patients with a median age of 63 (mean 58, range 17–86). The majority of patients were in the seventh decade. 62 were non-unions, eight were for fusion of docking site and one for fusion of an osteotomy. Circular external fixation was used in 20, IM nails in four, and plate fixation in 47. Indications for using BMP7 as opposed to bone graft included advanced age, immunosuppressive comorbidities or medication and obesity. In 65 cases bony union was achieved after the index procedure and one patient needed further surgery. There were five failures: two patients died before union and three failed to heal with the index intervention, leading to 74 procedures in 71 patients. BMP7 was used in several anatomic sites: femur (n=29), humerus (n=15), tibia (n=18) and in fusion of a joint (n=9). Overall success rate for achieving union was 93%. Local inflammation lasting a mean of three weeks was seen in six cases, and five patients developed heterotopic ossification, of which one was symptomatic.
Conclusion
BMP 7 can be used as a replacement for autologous bone graft with predictable success in situations where bone graft harvest may be deemed unsuitable either because of local or systemic factors.
