This 2005 narrative review by Khan et al. synthesizes the cellular and molecular biology of bone graft incorporation across all major graft types — autogenous cancellous and cortical bone, allograft, demineralized bone matrix, and massive osteochondral allografts — examining what determines success or failure at the host-graft interface.
When selecting a graft, match biology to the clinical need: use autogenous cancellous bone when osteogenesis is the priority (e.g., posterolateral spine fusion, fracture nonunion), reserve structural cortical allograft for mechanical support knowing it will be weak for months to years, and counsel patients that NSAIDs, steroids, and smoking each independently impair incorporation through distinct mechanisms.
This 2005 narrative review by Khan et al. synthesizes the cellular and molecular biology of bone graft incorporation across all major graft types — autogenous cancellous and cortical bone, allograft, demineralized bone matrix, and massive osteochondral allografts — examining what determines success or failure at the host-graft interface.
When selecting a graft, match biology to the clinical need: use autogenous cancellous bone when osteogenesis is the priority (e.g., posterolateral spine fusion, fracture nonunion), reserve structural cortical allograft for mechanical support knowing it will be weak for months to years, and counsel patients that NSAIDs, steroids, and smoking each independently impair incorporation through distinct mechanisms.