TABLE VI.

Advantages and Disadvantages of Adjunctive Therapies for Core Decompression

Treatment	Advantages	Disadvantage(s)
Autologous strut-grafting	May provide structural support Can be obtained from patient in same surgical setting Osteoconductive, osteoinductive, and osteogenic No risk of disease transmission	May lead to harvest-site morbidity May increase surgical time
Autologous bone chips	Can be obtained from core reamings without additional procedure Osteoconductive, osteoinductive, and osteogenic No risk of infection or graft rejection	Limited availability
Allogeneic bone-grafting	Readily available May provide structural support if a strut graft is used (i.e., the Phemister technique) No donor-site morbidity Additional cost Small risk of infection or graft rejection	Less inductive than autogenous grafts Could theoretically lead to disease transmission, although this should be quite low and has not been reported
Synthetic bone substitute	Easily obtainable, no harvest-site morbidity Osteoconductive	Additional cost Not osteoinductive or osteogenic
Bone morphogenetic protein	Growth factor with known osteoinductive properties May increase new bone formation	Additional cost May be associated with concerning side effect profile* Not osteoconductive, would require a scaffold for bone formation (i.e., bone graft) Considered as an “off-label” use
Tantalum rod	May provide structural support	Questionable clinical efficacy May increase complications of subsequent arthroplasty Not osteogenic

^*Adverse effects may include heterotopic ossification, wound complications, inflammatory reactions, induction of structurally abnormal bone, and osteoclast ossification.