Comparative outcomes of autograft versus rhPDGF-BB in rearfoot and ankle arthrodesis: A propensity-matched TriNetX analysis

Background: Recent evidence suggests that recombinant human platelet-derived growth factor (rhPDGF-BB) may enhance fusion and reduce donor-site morbidity in foot and ankle arthrodesis. However, direct large-scale comparisons between those receiving autograft and rhPDGF-BB remain limited, particularly for high-risk or revision procedures. Purpose: To address this gap, we utilized the TriNetX research database to compare fusion outcomes and complication profiles between rhPDGF-BB and autograft in tibiotalocalcaneal (TTC), pantalar, or triple arthrodesis. Methods: The TriNetX database for patients who underwent tibiotalocalcaneal, pantalar, or triple arthrodesis from 2003 to 2023, with at least one-year follow-up. A 1:1 propensity score match controlled for age, sex, body mass index, nicotine dependence, and comorbidities. Postoperative complications included implant-related infection, surgical site infection, superficial skin infection, infection-related reoperation, wound disruption, osteolysis, nonunion, and hardware removal. Statistical analyses were conducted on TriNetX using Z-tests for pairwise comparisons, with significance set at p < 0.05. Results: A total of 209 patients in the rhPDGF-BB cohort and 7,109 in the autograft cohort were identified. The rhPDGF-BB cohort was older and had higher rates of diabetes, HIV, and several other comorbidities (all p < 0.05). After propensity matching (n = 208 per cohort), the rhPDGF-BB cohort had a lower nonunion rate (OR 0.36; 95% CI 0.19-0.69; p = 0.001) with no other significant outcome differences. Conclusion: Our findings suggest that rhPDGF-BB may be associated with lower nonunion rates compared with autograft without increased complications. Given the observational design, these results should be considered hypothesis-generating and warrant validation in prospective randomized studies.