Comparison of Iliac Crest Marrow vs. Proximal Tibia Avitus® Bone Graft

Inclusion Criteria: * Patient must be 18 years of age or older. * Patient must be able and willing to sign the IRB approved informed consent. * Patient must consent to preoperative knee and pelvis radiographs to confirm no issue at harvest location. * Patient has indication for autograft bone harvest (undergoing any ankle or hindfoot fusion, complex mid and forefoot fusions requiring graft supplementation, treatment of fuse and fracture nonunions) * Patient is indicated for proximal tibia autograft harvest and iliac crest BMA (e.g. no hx bilateral TKAs or previous iliac wing trauma bilaterally). * Patient is skeletally "mature" and presents with no concern for osteopenia/osteoporosis. * Patient has sufficient volume of harvest material for study inclusion (minimum of 10 ml of cancellous bone graft plus 10 ml fluid pressed out from cancellous bone portion) * Patient must speak English or have access to sufficient translator. Exclusion Criteria: * Patient is 70 yrs of age or older. * Patient is unwilling or unable to give consent or comply with study protocol. * Patient has any condition, which in the judgement of the Investigator, places the patient at undue risk or interferes with the study. * Patient has mental or neurological disorder that will not allow for proper informed consent. * Patient is known to be pregnant or breastfeeding. * Patient is a vulnerable subject (prisoner, mentally incompetent or unable to understand what participation to the study entails, a known alcohol or drug abuser, and/or anticipated to be non-compliant). * Patient has any condition, which in the judgement of the Investigator, may chemically skew bone marrow. This may include but is not limited to the following: * Cancer * Undergoing chemotherapy radiation, * Bone marrow transplant * Infection at the donor sites * Organ transplant on antirejection meds * Usage of anti-rheumatologic drugs * Chronic steroid usage * Anemia * Myelodysplastic Syndromes * Patient presents with arthritis of the knee and may require knee replacement within the next 12 months.