Earlier this year, I attended a NASS symposium on Biologics, where one of the presentations focused on allograft materials. The presenter reviewed the literature on demineralized bone matrix (DBM), and the abstract below summarizes the findings of a 2017 systematic review. In short, there is limited evidence supporting the use of DBM—except for Grafton DBM, and only in the context of posterolateral lumbar fusions.
DBMs contain variable and generally low levels of bone morphogenetic proteins (BMPs), depending on donor source and processing methods. While DBMs are relatively inexpensive and widely used—and may indeed enhance bone grafting—they should, based on current evidence, be considered as supplemental to autograft or BMP-2 when necessary.
“The available evidence on demineralised bone matrix in trauma and orthopaedic surgery J. van der Stok, et al, Bone and Joint Research, 2017; 6: 423-432 – Objectives: The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery.
Methods: A total of 17 DBM products were used as search terms in two available databases: Embase and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. All articles that reported the clinical use of a DBM-product in trauma and orthopaedic related surgery were included.
Results: The literature search resulted in 823 manuscripts of which 64 manuscripts met the final inclusion criteria. The included manuscripts consisted of four randomised controlled trials (level I), eight cohort studies (level III) and 49 case-series (level IV). No clinical studies were found for ten DBM products, and most DBM products were only used in combination with other grafting materials. DBM products were most extensively investigated in spinal surgery, showing limited level I evidence that supports the use Grafton DBM (Osteotech, Eatontown, New Jersey) as a bone graft extender in posterolateral lumbar fusion surgery. DBM products are not thoroughly investigated in trauma surgery, showing mainly level IV evidence that supports the use of Allomatrix (Wright Medical, London, United Kingdom), DBX (DePuy Synthes, Zuchwil, Switzerland), Grafton DBM, or OrthoBlast (Citagenix Laval, Canada) as bone graft extenders.
Conclusions: The clinical level of evidence that supports the use of DBM in trauma and orthopaedic surgery is limited and consists mainly of poor quality and retrospective case-series. More prospective, randomised controlled trials are needed to understand the clinical effect and impact of DBM in trauma and orthopaedic surgery.
