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The primary performance endpoint was fusion rate evaluated with CT at six months. Safety was assessed based on the severity and incidence of adverse events. Functional evaluation was performed using the American Orthopaedic Foot &amp; Ankle Society (AOFAS) ankle-hindfoot score and pain was recorded using the Visual Analogue Scale (VAS).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>CT at 6 months showed that 85.3% had osseous bridging of the joint of \u2265\u200925%, 52.9% \u226550%, 8.8% &lt;25% and 5.9% showed no bridging. The AOFAS score increased significantly from 60.4\u2009\u00b1\u200917.6 points at operation to 68.6\u2009\u00b1\u200917.2 points at six months and to 73.5\u2009\u00b1\u200917.7 points at 12 months. The group with fusion rate \u226525% showed significantly higher AOFAS score than that with fusion rate\u2009&lt;\u200925% at 12 months. The mean VAS pain score at rest and during weight bearing decreased significantly (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) from operation to six and 12 months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This study demonstrated that \u03b2-TCP - NBP is a valuable bone graft substitute for fusion of ankle and hindfoot due to debilitating osteoarthritis and offers an alternative for autograft.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of evidence<\/jats:title>\n            <jats:p>Level II.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00264-025-06429-z","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T09:48:12Z","timestamp":1738662492000},"page":"721-728","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beta-tricalcium phosphate combined with native bone proteins (\u03b2-TCP - NBP): a novel bone graft substitute for ankle and hindfoot arthrodesis"],"prefix":"10.1007","volume":"49","author":[{"given":"Juhana","family":"Leppilahti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari","family":"Kuoppala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Sirola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukasz","family":"Kolodziej","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katri","family":"Ahonen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikko","family":"Aulamo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaakko","family":"Niinim\u00e4ki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7673-064X","authenticated-orcid":false,"given":"Pekka","family":"Jalovaara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"issue":"3","key":"6429_CR1","doi-asserted-by":"publisher","first-page":"499","DOI":"10.2106\/jbjs.f.01299","volume":"90","author":"M Glazebrook","year":"2008","unstructured":"Glazebrook M, Daniels T, Younger A, Foote CJ, Penner M, Wing K, Lau J, Leighton R, Dunbar M (2008) Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. 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Ethical approval for this study was obtained from The Ethics Committee of Human Sciences of University of Oulu, Finland (BBS-ARTEBONE, EETMK 42\/2013, 17.6.2013) and Ethics Committee of the Pomeranian Medical University in Szczecin, Poland (Resolution No. KB-0012\/38\/1 23 March 2015).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"There are no individual person\u2019s data in any form in this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"Pekka Jalovaara is a member of the board and shareholder of BBS-Bioactive Bone Substitutes Oyj and receives compensation as member of the board. The other authors do not have any financial interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}