Comparison of Anterior and Posterior Iliac Crest Bone Grafts in Terms of Harvest-Site Morbidity and Functional Outcomes

• Published in: Journal of bone and joint surgery. American volume Vol. 84; no. 5; pp. 716 - 720
• Main Authors: Ahlmann, Elke, Patzakis, Michael, Roidis, Nikolaos, Shepherd, Lane, Holtom, Paul
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01.05.2002; Journal of Bone and Joint Surgery Incorporated; Journal of Bone and Joint Surgery AMERICAN VOLUME
• Edition: American volume
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Bone Transplantation - adverse effects; Child; Female; Humans; Ilium - physiopathology; Ilium - transplantation; Male; Medical sciences; Middle Aged; Orthopedic surgery; Osteomyelitis - physiopathology; Osteomyelitis - surgery; Outcome Assessment (Health Care); Pain Measurement; Patient Satisfaction; Postoperative Complications; Recovery of Function - physiology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue and Organ Harvesting - adverse effects; Human; Prognosis; Donor site; Samplings; Morbidity; Autograft; Orthopedic surgery; Graft; Complication; Bone; Technique; Iliac crest; Comparative study
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200205000-00003

Background Previous studies have demonstrated high complication rates after harvest of iliac crest bone grafts. This study was undertaken to compare the morbidity related to the harvest of anterior iliac crest bone graft with that related to the harvest of posterior iliac crest bone graft and to determine differences in functional outcome.Methods The medical records of eighty-eight consecutive patients who had undergone a total of 108 iliac crest bone-grafting procedures for the treatment of chronic osteomyelitis from 1991 to 1998 were retrospectively reviewed. Demographic characteristics, the location of the harvest, the volume of bone graft that was harvested, the estimated blood loss, and postoperative complications were recorded. Fifty-eight patients completed a questionnaire pertaining to postoperative and residual pain, sensory disturbances, functional limitations, cosmetic appearance, and overall satisfaction with the bone-graft harvesting procedure.Results Sixty-six anterior and forty-two posterior bone-graft harvest sites were evaluated at a minimum of two years after the operation. A major complication was associated with 8% (five) of the sixty-six anterior sites and 2% (one) of the forty-two posterior sites. The rates of minor complications were 15% (ten) and 0%, respectively. In the series as a whole, there were ten minor complications (9%) and six major complications (6%). The rates of both minor complications (p = 0.006) and all complications (p = 0.004) were significantly higher after the anterior harvest procedures than they were after the posterior procedures. The postoperative pain at the donor site was significantly more severe (p = 0.0016) and of significantly greater duration (p = 0.0017) after the anterior harvests. No patient reported functional limitations at the latest follow-up evaluation.ConclusionsIn this series, the complication rate was lower than those previously reported by other investigators. Harvest of a posterior iliac crest bone graft was associated with a significantly lower risk of postoperative complications. On the basis of the results of this study, we recommend that iliac crest bone graft be harvested posteriorly whenever possible.