From the Research
Bone marrow infusion is unlikely to stimulate significant bone growth one year after a Lapidus procedure (first tarsometatarsal fusion). At this point, the surgical site has typically completed its healing process, with fusion either successfully achieved or established as a nonunion. Bone marrow aspirate concentrate (BMAC) contains stem cells and growth factors that can promote bone healing, but its effectiveness is greatest during the early healing phase, typically within the first few months after surgery.
Key Considerations
- The Lapidus procedure has evolved over the years, with improvements in techniques and materials leading to better outcomes, as noted in a study from 1.
- A more recent study from 2 highlights the excellent stable correction and high long-term patient satisfaction achieved with the Lapidus procedure for moderate to severe hallux valgus deformity.
- For a one-year-old Lapidus fusion site, if there are concerns about incomplete healing or nonunion, more established interventions would be recommended, such as revision surgery with additional bone grafting or fixation, as suggested by the principles outlined in 3 and 4.
- Clinical reasoning, as emphasized in 5, plays a crucial role in making decisions for individual patients, considering the unique aspects of each case and the limitations of evidence-based guidelines.
Recommendations
- If experiencing pain or mobility issues one year post-procedure, a complete clinical and radiographic evaluation is necessary to determine the exact status of the fusion and identify the true source of any symptoms before considering treatments like bone marrow infusion.
- The timing of bone marrow infusion is critical, with its osteogenic potential working best in the active healing environment of fresh bone injuries, not in mature surgical sites where the biological healing process has already concluded.