infection risks and
can be molded into
various shapes and
sizes for easier
placement. They
provide a frame-
work for bone to
grow, but don't stim-
ulate bone growth.
"Operative times
are shorter with
synthetic bone sub-
stitutes because sur-
geons don't have to
harvest local grafts," says Dr. Stahel. "Risks of complications, includ-
ing infection, bleeding and post-op pain, are also lower."
However, the likelihood of successful fusion is less than if auto-
grafts are used, says Dr. Stahel. Autograft bone is also free, but you
have to factor in the costs of additional OR time and the risks of anes-
thetizing patients for longer periods and adding an operative site to
harvest the graft.
Dr. Stahel says bone substitute manufacturers do an excellent job of
marketing their products, as evidenced by patients seeking out facili-
ties that use the latest synthetic grafting materials.
Bone grafts are reserved for treating bone loss during revision sur-
gery after implants fail or to augment bone around fractures that
occur in replaced joints, less so for primary fracture fixation and pri-
mary joint replacements.
Dr. Stahel says the burden of proof is on manufacturers to show
through human studies and case reports that synthetic products are
9 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 1 8
• TAKE TWO Bone grafting is often needed to help restore a patient's joint function
during revision total knee replacements.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
