Dr. Öğr. Üyesi Görkem Kıyak
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Fractures & Trauma
Infuse bone graft
What the Infuse bone graft is, how its rhBMP-2 protein on a collagen sponge stimulates new bone, which uses are approved and which are off-label, how it compares with graft taken from your own hip, approximate surgery costs in Turkey against the UK, US and Germany, recovery milestones, the known risks and the questions to ask a surgeon.
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What is the Infuse bone graft?
The Infuse bone graft is a product made by Medtronic that contains recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge. BMP-2 is a growth factor that the body itself uses to tell cells to become bone-forming cells. In surgery the sponge is soaked in the protein solution and placed where new bone is needed. It is a bone graft substitute rather than a graft taken from you or from a donor, and it is used in a small number of operations, mainly spinal fusion, certain open fractures of the shin bone and some jaw bone reconstructions.
This guide explains how Infuse works, where its use is approved and where it is off-label, what the evidence says, how it compares with a graft from your own hip, what it adds to the cost in Turkey against the UK, US and Germany, and which risks to discuss. It is an orthopaedic and spinal matter, so see our orthopedics treatments in Turkey hub for the operations in which it is used.
How does Infuse stimulate bone to grow?
After the surgeon has prepared the bone surfaces, the collagen sponge carrying rhBMP-2 is placed in the gap or inside a fusion cage. The protein is released slowly as the sponge dissolves over days to weeks. It attracts stem cells to the area and signals them to turn into bone-forming cells, so that new bone bridges the gap. The metal rods, plates or cage used in the operation hold the bones still while this happens, and the growth of solid bone typically takes several months. The dose is fixed by the product size and the manufacturer's instructions, which is one reason surgeons use it only for approved or well-justified indications.
For which operations is Infuse approved, and what is off-label?
The US Food and Drug Administration (FDA) has approved Infuse for specific uses: lumbar spinal fusion from the front of the spine with a particular cage, open fractures of the tibia (shin bone) stabilised with a rod, and certain jaw operations, namely sinus augmentation and ridge augmentation after tooth extraction. Many other uses are off-label, including fusion from the back of the spine, other levels, and the neck. In 2008 the FDA issued a public health notification about life-threatening swelling in the neck and throat after the use of rhBMP-2 in cervical spine surgery, where it is not approved. If a surgeon proposes Infuse, ask whether your operation is on-label and why.
Does the Infuse bone graft work?
For the approved indications, trials showed that rhBMP-2 can produce fusion at rates comparable to, and sometimes above, graft harvested from the hip, while avoiding a second operation site. Later independent reviews, however, found that early reports understated complications and that the benefit over a hip graft is smaller than first suggested for some uses. A balanced reading is that Infuse can help in selected patients, especially when the patient is at higher risk of a failed fusion, and that it is not a routine upgrade for every spinal operation. Honest clinics describe both effects and do not promise fusion.
Infuse, your own bone or another substitute: which options exist?
The surgeon has several ways to encourage bone to join. Autograft, bone taken from your own hip, is the long-established standard and carries living cells, but causes pain at the donor site. Allograft is donor bone from a tissue bank. Demineralised bone matrix and ceramic substitutes add a scaffold with a smaller bone-inducing signal. Infuse supplies a strong signal but no scaffold of its own, and is paired with a cage or carrier. Our page on bone graft compares the main types in more detail.
| Graft option | Best suited to | Typical limits |
|---|---|---|
| Infuse (rhBMP-2 on a collagen sponge) | Approved fusion, fracture and jaw uses; patients at higher risk of non-union | Specific risks (swelling, abnormal bone growth); higher material cost; off-label use is contested |
| Your own bone (autograft) | Most routine fusions and fractures | Second incision; pain at the donor site; limited quantity |
| Donor bone or substitute (allograft, matrix, ceramic) | Filling defects and supporting fusion without a donor-site wound | Weaker bone-forming signal; fusion may be slower |
Infuse bone graft cost in Turkey compared with the UK, US and Germany
Infuse is not sold as a stand-alone treatment. It is an implant used in an operation, so the price you pay is for the whole procedure, and the product adds to it. The figures are approximate ranges for a typical single-level operation that uses Infuse, not hospital quotes, and differ greatly by operation and hospital. Each hospital confirms its price in a written quote.
| Country | Approximate cost of the operation including Infuse |
|---|---|
| Turkey | €7,000 – €20,000 |
| United Kingdom | €18,000 – €40,000 |
| United States | €40,000 – €120,000 |
| Germany | €15,000 – €35,000 |
The price depends on the operation (a short jaw graft costs far less than a spinal fusion), the number of levels, the size of the Infuse kit, the other implants such as a cage, screws and rods, the length of the hospital stay and any intensive-care need. A package normally includes the surgery, anaesthetist, implants, hospital stay and first physiotherapy; ask for the Infuse kit to be itemised and ask for the product's batch label to be placed in your records.
Who is considered for an Infuse graft, and who is not?
A surgeon may consider it when there is a higher chance of a failed fusion, for example after a previous fusion that did not unite, in smokers who cannot stop, in some patients with diabetes, or when taking bone from the hip is undesirable. It is not suited to everyone: the label advises against use in people with an active infection near the site, an allergy to the product, a tumour at the site or in whom the skeleton is still growing. It should not be used in pregnancy. Because of the cancer question raised in some studies, your surgeon should discuss your personal history.
How is Infuse used in surgery, step by step?
The operation is done under general anaesthesia, and its duration depends on the procedure. After the incision and preparation of the bone, the surgeon prepares the kit: the protein solution is added to the sponge and left for a short time as the manufacturer directs. The soaked sponge is placed in the cage, or in the defect, and the surgeon then fixes the bones with screws or rods. The wound is closed in layers, usually with a drain for a day or two. You then spend a few nights in hospital, depending on the operation. Our guide to bone fracture treatment explains how fractures are fixed in the first place.
Recovery after an Infuse graft: how long does it take?
Recovery is set by the underlying operation, not by the graft. For a lumbar fusion most people spend three to five days in hospital, walk the first day, and stay in Turkey for about seven to ten days so the surgeon can check the wound and the first X-ray. Light work often resumes after four to eight weeks, and bone fusion is judged on X-ray or CT over three to twelve months. Smoking, nicotine patches and some anti-inflammatory drugs can slow fusion, so follow the surgeon's advice. Report fever, swelling in the throat or neck, new leg weakness or wound drainage at once.
Risks and side effects of the Infuse bone graft
Every operation carries the usual risks of infection, bleeding, blood clots and anaesthetic complications. Reported risks specific to rhBMP-2 include swelling at the site (very serious in the neck), bone growing in unwanted places (ectopic or heterotopic bone), irritation of nerve roots, bone resorption around the implant before new bone forms, seroma and, in front-of-spine lumbar surgery, a risk of retrograde ejaculation in men. The long-term cancer question remains debated, and the FDA label lists warnings. A clinic should give you the manufacturer's patient information leaflet and should be able to explain why Infuse is proposed instead of your own bone.
How to choose a surgeon and hospital for a graft-assisted operation
Check that the surgeon is an orthopaedic or neurosurgeon registered in Turkey with regular experience of your operation, that the hospital has intensive-care and imaging facilities, and that you receive a written plan that states whether Infuse is on-label for you. Red flags include a promise of guaranteed fusion, a quote that does not itemise implants, no explanation of alternatives and no plan for follow-up scans. Questions to ask:
- Is Infuse approved for my operation and spinal level, or is it off-label?
- What is the alternative if I do not use it, and what difference would it make?
- What does the Infuse kit cost, and is it listed separately in the quote?
- Who reviews my X-rays and complications once I am home?
- Will I receive the implant and product labels in my records?
Read how it works, then send your scans through the free quote page. If a different operation, such as resection of the bone, is what you need, the surgeon will say so after reviewing your images.
Hospitals with Orthopedics in Turkey
Frequently asked questions
Infuse is a Medtronic product made of rhBMP-2, a bone-growth protein, on an absorbable collagen sponge. It is placed during surgery to stimulate new bone, mainly in spinal fusion, some open shin fractures and some jaw bone reconstructions.
For approved uses it can produce fusion at rates similar to a hip bone graft, and sometimes higher. Later reviews found a smaller benefit and more complications than first reported, so it helps selected patients rather than all.
Infuse is part of an operation, so the whole procedure is priced. Approximate ranges are €7,000 to €20,000 in Turkey against €18,000 to €40,000 in the UK, depending on the operation. Ask the hospital to itemise the kit.
No. Hip bone is living tissue from your body but causes pain at the donor site. Infuse is a protein signal on a sponge that avoids that wound. Each has its own risks and the surgeon should explain the choice.
Reported effects include swelling at the site, bone growth in unwanted places, nerve root irritation, bone loss around the implant and, in front-of-spine surgery, retrograde ejaculation in men. The FDA also warns against neck use.
No. The FDA has issued a public health notification about serious swelling in the neck and throat after rhBMP-2 use in the cervical spine, where it is not approved. Ask whether your use is on-label.
Recovery follows the main operation. After a lumbar fusion, expect three to five days in hospital, light work after four to eight weeks and fusion confirmed by scans over three to twelve months.
Smoking slows bone healing and may be one reason a surgeon considers a stronger graft, but it also raises the risk of a failed fusion. Most surgeons ask you to stop nicotine before and after the operation.
Plan around seven to ten days: three to five in hospital and the rest for wound checks and a first X-ray. Your surgeon will confirm when it is safe to fly, and follow-up scans continue at home.
Alternatives are bone from your own hip, donor bone from a tissue bank, demineralised bone matrix and ceramic substitutes. Each has different benefits and limits, and the choice depends on the operation and your risk factors.
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