Evidenzbasierte Evaluation intraoperativer biologischer Augmentation und deren Komplikationspotenzial

Background: In orthopedic surgery an increasing number of intraoperative biological augmentation techniques have become part of clinical practice. Therefore, it is essential to evaluate these methods carefully according to evidence-based guidelines (level of evidence and grade of recommendation) and to compare them to established surgical techniques. Methods and results: Biological augmentation options include isolated growth factors, stem cells and platelet concentrate applications. In the growth factor sector there are only scarce level 1 studies for bone morphogenic proteins 2 (BMP 2) and 7 which demonstrate obvious improvements in bone healing; however, a clear recommendation cannot be concluded. Isolated stem cells are currently only used in preclinical studies. Current data from clinical research projects on platelet concentrates do not justify consistent recommendation because of barely comparable data due to the variety of different preparation techniques and corresponding inhomogeneous composition of the concentrates. In addition the adverse effects of a possible overstimulation of the healing response cannot yet be excluded. Conclusion: None of the novel treatment options apart from the established techniques (e.g. autologous cancellous bone grafts) have demonstrated sufficient evidence-based power to allow a high grade of recommendation (A).