Background Although autologous grafts remain the reference in reconstruction of bone defects, due to donor site morbidity, resorting to bone substitutes is widely used in orthopaedic and traumatology surgery. For surgeons, choosing between human origin substitute and synthetic ones in clinical practice is not so obvious. After a critical analysis of the literature, there is no evidence for considering one product is more cost effective than another.

Purpose To identify the clinical practice of bone substitution, to facilitate informed decision-making and evaluate potential savings that could be made.

Materials and methods A six-month retrospective study of bone substitute use was conducted in orthopaedic and traumatology surgery in Lyon Sud Hospital. Patient files were reviewed by pharmacists and surgeons. Data related to patient (anthropometrics and pathology), indication and bone graft were analysed in accordance with technical and clinical criteria.

Results We reviewed 57 cases of implantation of bone substitutes: 91% human origin grafts; 9% synthetic grafts. 85% came from the tissue bank. Choice of different substitutes depended on indication: hip replacement, osteotomy, arthrodesis, nonunion. Some osteotomies were practiced with different kinds of graft (human, synthetic) depending on professional experience. 40,163 euros were spent. We suggested another less expensive graft for each case. Savings of 8756 euros would have been made with synthetic grafts and 8579 euros with TBF tissue engineering human grafts.

Conclusions Because of the lack of guidelines, bone substitute use is surgeon dependent. Practice should be analysed in order to save money. Substitution has been proposed during a committee, and seems to be accepted by surgeons. This study will be conducted in other surgical specialties in Lyon Sud Hospital.

No conflict of interest.