Biologics in Foot & Ankle Surgery

Fusion and Fracture Management

Bone regeneration remains a major challenge in orthopedics. Large defects from trauma, infection, or tumor resection often exceed natural healing capacity, resulting in about 2.2 million bone graft procedures annually. Autologous grafts are the gold standard, but they are limited by donor site morbidity and restricted availability.^2-5

Biologic Adjuncts for Bone Void Filling

Synthetic biomaterials mimic the biochemical and mechanical properties of bone and provide predictable clinical outcomes.

Arthrodesis procedures show comparable outcomes when using synthetic grafts versus autograft bone.⁶

Synthetic bone substitutes offer reliable osteoconductive performance, and PRP can further enhance the overall healing potential.

Biologic Adjuncts for Bone Void Filling

Scientific Insights

Bone substitutes are needed in about 10% of all orthopedic surgeries.⁶ Current evidence shows that autograft as well as synthetic bone graft substitutes can be successfully used in several indications in foot and ankle surgery.

Current evidence describes consistent performance of synthetic bone substitutes across common indications.⁶

Clinical Outcomes

Autograft:

Gold standard⁵‍
Strong biological properties⁵

Synthetics:

Comparable fusion outcomes⁶
Adjunct PRP enhances bone regeneration⁹

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Common Indications for Bone Grafting in Foot & Ankle Surgery

Ankle and hindfoot arthrodeses
Triple or subtalar fusions
Calcaneal fractures
Metaphyseal defects
Cysts

References

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Key Takeaways

Predictable Outcomes: Synthetic substitutes are reliable osteoconductive fillers for well-defined indications
Biologic Synergy: Combining synthetic biomaterials with PRP or fibrin derivatives delivers both structural support and biological activity in one hybrid system

Study Limitations

Long-term data for some synthetic materials is limited
Cost considerations and variable resorption rates
High-level clinical evidence is required

Biologic Adjuncts for Bone Void Filling

References

Xie RX, et al. Advancing bone regeneration: Clinical implications of synthetic biomaterials and fibrin derivatives. World J Orthop. 2025 Aug 18;16(8):109149. doi: 10.5312/wjo.v16.i8.109149
Lewandrowski K U,et al. Bioresorbable bone graft substitutes of different osteoconductivities: a histologic evaluation of osteointegration of poly(propylene glycol-co-fumaric acid)-based cement implants in rats. Biomaterials. 2000;21(8):757-764. doi:10.1016/s0142-9612(99)00179-9
Fernandez-Yague MA, et al. Biomimetic approaches in bone tissue engineering: Integrating biological and physicomechanical strategies. Adv Drug Deliv Rev. 2015;84:1-29. doi:10.1016/j.addr.2014.09.005
Dimitriou R, et al. Bone regeneration: current concepts and future directions. BMC Med. 2011;9:66. doi:10.1186/1741-7015-9-66
Pape HC, et al. Autologous bone graft: properties and techniques. J Orthop Trauma. 2010;24 Suppl 1:S36-S40. doi:10.1097/BOT.0b013e3181cec4a1
Hoveidaei AH, et al. Effectiveness of synthetic versus autologous bone grafts in foot and ankle surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024 Jul 13;25(1):539. doi: 10.1186/s12891-024-07676-8
Ivanova N, et al. Types of bone substitutes and their application in regenerative medicine: A systematic review. J Funct Biomater. 2025 Sep 9;16(9):341. doi: 10.3390/jfb16090341
Cho JH, Song HK. Current concepts and applications of bone graft substitutes in orthopedic surgery. J Musculoskelet Trauma. 2025;38(4):169-177.
Pagani BT, et al. Update on synthetic biomaterials combined with fibrin derivatives for regenerative medicine: Applications in bone defect treatment: Systematic review. World J Orthop. 2025;16(5):106181. doi:10.5312/wjo.v16.i5.106181