Bone graft substitutes: Claims and credibility

Periprosthetic bone loss remains a significant challenge during revision arthroplasty. Traditional approaches for reconstruction of the bony envelope include both autograft and allograft tissue in structural and cancellous forms. In recent years, the proliferation of commercially available bone substitutes provides the surgeon with many different reconstruction options. These include allograft-based, ceramic-based, factor-based, and polymer-based substitutes. This review will describe the characteristics of these bone substitutes and provide evidence-based recommendations from the clinical and basic science literature on their use. Demonstrating cost-effectiveness and clinical utility is critical to justify the use of these compounds in the future.