Hospital Bone Bank Research Articles

The quality assessment of the University hospital bone bank in Central Serbia: the second audit after fourteen years.

We analyzed the prevalence and predisposing factors for the overall rejection rate after retrieval of 267 fresh femoral head allografts over the past 7 years. The present study aimed to assess the quality system of institutional bone banking that can provide high-standard allografts with a low infection rate. Retrospective analysis of bone banking from June 2013 to December 2019 was conducted on 267 donors and 153 recipients. Of the 267 donated femoral heads, 74 were rejected, giving an overall rejection rate of 27.71%. The leading cause of allograft rejection was the inability to perform serology tests due to donor death; the absence of serological tests itself, and the donor refusal to perform the serology 6-month retest in 42 donors (15.72%). At retrieval, 12 allografts were positive, giving an overall contamination rate of 4.49%. Seven (2.62%) of the 267 allografts failed the blood screening tests. Thirteen allografts (4.86%) were discarded because of suspected damage to the packaging or disuse during surgery. An infection rate of 1.30% was found following transplantation. Over the past 7 years of bone banking, our results show that the overall rejection rate and the allograft-related infection rate correlate with international standards. The leading cause of allograft rejection was the inability to perform serology tests due to donor death and their refusal to perform the serology retests. Besides stringent aseptic allograft handling, donor motivation to participate in bone banking is extremely important for its efficient functioning.

Reducing allograft contamination and disease transmission: intraosseous temperatures of femoral head allografts during autoclaving.

The Singapore General Hospital Bone Bank, which exclusively stores femoral head allografts, relies on flash sterilisation to prevent allograft-related disease transmission and wound infection. However, intraosseous temperatures during autoclaving may be lower than required to eliminate human immunodeficiency virus, and hepatitis B and C viruses. The aim of this study is to determine the intraosseous temperatures of femoral head allografts during autoclaving and to assess the adequacy of autoclaving in preventing disease transmission. Six femoral heads were acquired from patients who underwent hip arthroplasty. The specimens were divided into two groups. The first group underwent flash sterilisation with a sterilisation time of 4 min, while a longer sterilisation time of 22 min was used for the second group. The highest core temperature in the first group was 130°C, while the core temperatures in the second group plateaued at 133°C for all allografts. In the first group, only smaller allografts maintained temperatures sufficient for the inactivation of the clinically relevant viral pathogens. In contrast, all allografts in the second group were terminally sterilised. There is an inverse correlation between the size of allografts and intraosseous temperatures achieved during autoclaving. Therefore, we recommend dividing large allografts into smaller pieces, in order to achieve intraosseous temperatures adequate for the elimination of transmissible pathogens during flash sterilisation. Allografts should not be terminally sterilised, as the resulting allografts will become unusable. Despite modern processing techniques, stringent donor selection remains vital in the effort to prevent allograft-related infections. Autoclaving is an economical and efficacious method of preventing allograft-related disease transmission.

Simple novel bone bank storage: the Singapore General Hospital experience.

Since 1981, the Singapore General Hospital (SGH) bone bank has proven to be a safe, reliable, and economical source of bone allografts. Femoral heads are used exclusively and are procured from patients undergoing hip arthroplasty. Screening for HIV, hepatitis B, and hepatitis C is carried out prior to surgery. Patients with ongoing infection and past history of malignancy are excluded. The bone graft procured is washed and autoclaved to 134°C for 3 minutes. It is then stored in saline solution containing penicillin and streptomycin at -80°C. Based on our experience, such a system can be readily duplicated in developing nations with minimal cost and equipment. This article presents our experience in the procurement and storage of femoral head allografts with clinical results to support the safety profile. Ten femoral heads were harvested from patients who underwent hip arthroplasty. The femoral heads were autoclaved and stored at -80°C in an antibiotic solution. Bone chips were sent for culture immediately after autoclaving and at 3 and 6 months. All specimens passed the initial sterility testing and remained sterile up to 6 months. A retrospective study of 9 patients who had 13 allografts implanted between 2008 and 2010 showed that none of the recipients acquired an infection or transmissible disease due to the allografts. This study showed that our protocol allows for procurement of femoral head allografts with minimal contamination and that they can maintain sterility for up to 6 months. This finding is further supported by our clinical results. Hence, this protocol will be useful for bone banks in developing nations where sterility conditions are suboptimal and cost is an issue.

Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors

In the advent of the EU guidelines 2004/23/EG and 2006/17/EG requiring extensive safety and quality steps in bone banking, the prevalence and risk of infection disease transmission from bone allograft needs to be reconsidered. Therefore, we prospectively reviewed the screening process of bone donations and the outcome of surgeries utilizing bone allografts from our internal hospital bone bank with regard to infections according to CDC criteria. One-hundred and eighty-eight allogenic bone transplantation procedures in 160 patients were followed-up for 12-64 months (mean 32 months). Bacterial infection occurred in 11 patients, the overall infection rate therefore was 6.9%. After review of the clinical and intraoperative findings, none of the infections were likely to have been caused by the bone graft. Although no follow-up serologic testing was performed, no HIV of hepatitis infections were observed. Frozen bone allografts derived from live donors and provided by hospitals can generally be considered safe. However, without new and relevant clinical expertise, continuing this technique will be impeded by the new EU guidelines and their national implementations.

Effektivitätsanalyse einer klinikinternen allogenen Knochenbank

The EU guidelines 2004/23/EG and 2006/17/EG and their national implementation redefine the framework for allogenic bone banking and transplantation. Against this background an established internal hospital bone bank was analysed concerning threshold of allogenic bone and cost effectiveness in comparison to alternative methods. Over a 30-month period we registered all arrivals and outgoings of our bone bank and their destination. We further noted all declined donations. We analysed all costs incurred and calculated costs for alternative methods. By means of our bone bank we are currently able to meet our own demand for bone substitutes. The maintenance costs are below the prices of alternative methods. Some donations (8%) have to be discarded due to procedural errors. Maintaining an internal hospital bone bank utilizing fresh-frozen allogenic bone is an efficient and cost-effective method of supplying bone substitutes even under the new EU guidelines if the existing process covers most conditions of the producer authorisation according to section sign 13 AMG. By harmonizing the organizational process it is possible to further improve its effectiveness.

Status of Bone Allografting in Japan - Nation-Wide Survey of Bone Grafting Performed from 1995 through 1999.

We report the status of bone allografting in Japan on the basis of the information obtained through questionnaires performed by the Japanese Orthopaedic Association (JOA). JOA performed a nation-wide survey in 2000, in order to clarify the current status of musculoskeletal tissue grafting in the orthopaedic practices in Japan. Conducted period was for 5 years from 1995 to 1999. As the results of this survey, it had been clarified that 92,984 bone graftings, which included autografts, allografts and synthetic bone substitutes, were performed during conducted 5 years. While the allografts were used only in 3,212 cases (3%), autograftings were performed in 64,193 cases (69%), synthetic bone substitutes were used in 25,576 cases (28%) in this series. The proportion of the number of operations for use bone substitutes increased every year, whereas that autografting decreased. The proportion of the number of allografting remained almost unaltered. Of the 706 institutions which answered to have experiences of tissue grafting, only 193 (27%) performed allograft.Since Kitasato University Hospital Bone Bank was developed in 1971, we have applied to clinical while doing basic research for preserved bone allograft. When extensive bone graft is required, allograft is very useful. In Japan, however, allograft is not performed widely. The foundation of regional bone banks is expected to resolve this problem. Since excision of bone preparations from cadaver donors is not common, bone allografts are not supplied sufficiently at present. It is needed to develop a network connecting bone banks in Japan. The enlightenment activities to the ordinary people and medical institutions will also be required.

Bone bank service in Odense, Denmark. Audit of the first ten years with bone banking at the Department of Orthopaedics, Odense University Hospital.

There has been an increase in the demand for allograft bone in recent years. The Odense University Hospital bone bank has been in function since 1990, and this paper outlines our results during the 10 year period 1990-1999. Potential donors were screened by contemporary banking techniques which include a social history, donor serum tests for HIV, hepatitis B and C, and graft microbiology. The bones were stored at -80 degrees C. No type of secondary sterilisation was made. 423 femoral heads were approved and donated to 300 patients,1-6 heads/operation. The allografts have been used mainly to reconstruct defects at revision hip arthroplasty (34%), and for fracture surgery (24%). 7 % of all transplanted patients were reoperated because of infection. In the hip revision group the infection rate was 4 %. There were no cases of disease transmission. During the 10 year period there was a change in the clinical use of the allografts. In the first years the allografts were mainly used for spinal fusion surgery, but today the majority are used in hip revision and fracture surgery. The clinical results correspond to those reported in larger international series.

BONE BANKING: FROM TAMWORTH BASE HOSPITAL TO ROYAL NEWCASTLE HOSPITAL

During the first 6 months of 1992, orthopaedic surgeons at Tamworth Base Hospital were involved in a feasibility study using allograft bone and donating femoral heads to Royal Newcastle Hospital Bone Bank. The two hospitals being separated by 300 km meant that storage, packaging and transportation had to be refined in order to ensure sterility and safe delivery of the bone. This study was undertaken because of the growing need for allograft bone in revision hip arthroplasty at Tamworth Base Hospital. This need for allograft bone has been expressed by other country based orthopaedic surgeons and will only increase during the next few years as primary hip prostheses age and revision hip surgery continues to advance.

Frozen musculoskeletal allografts. A study of the clinical incidence and causes of infection associated with their use.

A retrospective study was performed to determine the clinical incidence and causes of infection related to the use of frozen musculoskeletal allografts. The results of this study of 324 grafts, prepared and supplied by our hospital bone bank, showed that the patients in whom femoral head grafts and other small bone and soft-tissue allografts were used had a negligible clinical incidence of infection. The incidence of infection related to the use of large allografts, such as osteoarticular or diaphyseal grafts, was approximately 5 per cent in patients who had treatment for a bone tumor and 4 per cent in those who had revision of a hip arthroplasty. These rates of infection were not substantially different from those that have been reported in similar series in which large allografts or sterilized prosthetic devices were used. The causes of the infections were difficult to determine, but contamination of the allograft was probably not a factor in most patients.

Operational and financial aspects of a hospital bone bank.

Although bone banks have existed for many years, the elements of organizing and maintaining a hospital bone bank have not been well documented. The experience with a bone bank at the Massachusetts General Hospital between 1971 and 1980 provides a model on which to base an explanation and discussion of methods of procurement, storage, and retrieval, and the costs associated with such a facility. In 1979, the procurement rate averaged one donor per month; during that year a total of ninety-one bones were stored and six different surgeons utilized more than twenty allografts from the bank. During the same year, the approximate cost of maintaining the bank was more than $50,000. On the basis of the number of bones used, the cost averaged more than $2000 per implant. Such a hospital facility offers the benefits of quality control of the banked bone but is expensive and may not be feasible for many hospitals.

Oakland Hospital's Bone Bank

Oakland Hospital's Bone Bank