Assessment of Bone Marrow Aspiration Site Pain in Foot and Ankle Surgery

Bone marrow aspiration (BMA) is a validated technique to harvest progenitor cells. BMA has many uses in foot and ankle surgery; however, donor site morbidity is a concern. The purpose of this study was to compare the Visual Analog Scale (VAS) pain scores after BMA at 3 different sites (iliac crest, distal tibia, and calcaneus) over a 12-week postoperative recovery period. This was an institutional review board-approved prospective study of 40 patients who underwent BMA as an adjunct to their primary foot and ankle procedure. Each patient had BMA harvested from the ipsilateral anterior iliac crest, distal tibia, and lateral calcaneus at the time of surgery. Patient follow-up questionnaire forms were filled out at 2, 4, 8, and 12 weeks, with the primary outcome measure being VAS pain scores. Mean VAS scores averaged over the 12-week follow-up period were significantly higher in the calcaneus (20.8 ± 28.6) compared with the distal tibia (7.7 ± 17.6) and the iliac crest (4.2 ± 12.4; P < .05). No significant difference was found between the distal tibia and the iliac crest sites. At 12 weeks, all sites were about equal and without appreciable pain. Our data suggested that donor site selection for BMA affects postoperative pain levels, with BMA from the calcaneus resulting in significantly higher pain scores when compared with the iliac crest or distal tibia. The VAS pain score for the calcaneus was likely confounded by the high number of hindfoot/ankle surgeries performed in the ipsilateral foot.

Levels of evidence: Therapeutic, Level II: Prospective, comparative trial.