A Bone to Pick With Allograft Wedges

by Vince Vacketta, DPM

Corrective wedges are a useful tool for deformity correction and arthrodesis during reconstructive surgery. In the past, tri-cortical autografts were the only option available. However, over the years, the field of corrective wedges has advanced significantly. Now, there are various options, including precontoured allograft bone, metallic wedges, PEEK (polyether ether ketone) wedges, and custom corrective wedges. 

While many of these implants have improved convenience of implantation, a recent study highlights some drawbacks associated with using allograft bone. Over a period of five years, 334 allograft bone wedge implantations were performed, and graft resorption was observed in 24 cases. Out of these, ten cases progressed to non-union. The study concluded that factors such as age, BMI, and anatomic location of the implant significantly influenced the rates of resorption/non-union. Plot twist: Interestingly, the authors specifically reported issues with the Paragon 28 precontoured wedges.

Takeaway

Alternative wedge options offer improved consistency and convenience, but each material comes with its own unique limitations. These limitations should be carefully considered in conjunction with patient characteristics and the specific procedure being performed. The search for a universally reliable wedge substrate continues.