Background. Revision hip arthroplasty for excessive bone loss because of osteolysis or infection is difficult theme. Bone grafting is essential technique for bone loss and need of allograft is increasing. Recently, many hospital bone banks are established in Japan. The aim of this study is investigate efficacy and safety of allograft in our hospital bone bank. Material and method. We evaluated management, result and complication of allografts retrieved from living donors in our institute. Result. All donors meet the criteria of Japanese Orthopaedic Association (JOA) guideline and gave fully informed written consent. We obtained 75 femoral head grafts that were retrieved during primary total hip arthroplasty under sterile operating theatre conditions. No donor had hepatitis B and C, human immunodeficiency (HIV), Human T-cell leukemia (HTLV-1) and Syphilis. After heat treatment, allograft was swabbed for cultures and stored in freezer at −80□. All cultures ware negative and proved before implantation. We used allograft in 27 revision hip arthroplasty. Six cases were femoral side and 21cases were acetabular side. At the minimum of 3 months follow-up, 1 fracture of acetablar and 1 superficial infection occurred. No allergic reaction happened. Conclusion. Our bone bank thoroughly managed based on JOA guideline was effective and safe. Careful follow-up is needed for long-term implant fixation and osteoinduction

Impacted morsellised donor bone is succesfully used to treat bone loss in revision total hip arthroplasties. After implantation new bone is formed in the donor bone. It is generally thought, but not proven, that the processing and storage at −80°C of the donor bone kills all cells. There is however general concern about viral, bacterial, and/or oncogenetic contamination with donor bone. Based on these considerations it is essential to know whether the donor bone does contain viable bone cells. Fragmented biopsies from eleven femoral heads from our bone bank, which is processed according to the Musculo-skeletal Council of the American Associations of Tissue Banks (AATB) and the European Association of Musculo Skeletal Transaplantation (EAMST), were tested for their capacity to give rise to proliferating cells in vitro. This was repeated with five other femoral heads from the same bone bank after irradiation. Microscopic analysis of cell growth, aspect, and number was performed on the established cell cultures. DNA marker analysis of the cultured cells and freshly obtained buccal cells from the donor was done in order to verify the origin of the cultured cells. All fragmented biopsies showed cell growth. Cell outgrowth time as well as cell number varied between donors, and was independent of the length of storage time at −80°C. No cell outgrowth was observed from irradiated bone. DNA marker analysis showed identical alleles for cultured cells from frozen bone and DNA from freshly obtained unfrozen buccal cells from the donor. Biopsies from femoral heads from a bone bank according to the AATB and the EAMST contain living bone cells with growth capacity. It is unclear which role these vital cells play in the process of new bone formation in the donor bed, or in the risk of contamination

Bone infections due to fractures or implants are a big medical problem. In experimental medicine, many experimental models have been created on different animal species to simulate the disease condition and to do experience treatments. The aim of this paper was to present an antibacterial efficacy of using a bone allograft developed according to the Marburg system of bone bank on a model of chronic osteomyelitis induced in rabbits. In research was used 54 rabbits. Osteomyelitis was induced in rabbits by a human strain of St. aureus ATCC 43300, in the rabbit femur. There have been created 3 groups of animals. In 1. st. group used antibiotic impregnated biodegradable material “PerOssal”. In 2. nd. group used antibiotic impregnated whole bone allograft. In 3. rd. group used antibiotic impregnated perforated bone allograft. Evaluation of installation and evolution of the disease was done by microbiological. A separate study of microbiological data is presented here. This study showed, in the 1. st. and 3. rd. groups there is a persistent decrease in CFU by 14 knocks to 120.4 in the 1. st. group and to 3.5 in the 3. rd. group, and in the 2. nd. group, on the contrary, there is an increase in CFU to 237.33. This shows the lack of effectiveness of using a whole bone allograft. The results showed, after 7 days there was no statistically significant difference between the groups. After 14 days the perforated bone allograft impregnated with antibiotic was better than the biodegradable material “PerOssal”

Introduction: The National Bone Bank of Ireland was established in June 1996 at Cappagh National Orthopaedic Hospital, Dublin in response to the increased demand of allogenic bone grafts in Ireland. We reviewed the Bone Bank performance since it started with special emphasis on Microbiological monitoring of bone allograft as infection is the main complication of bone allograft (Chapman and Villar 1992). Material and Methods: The femoral head allograft is harvested from living volunteer donors who are undergoing primary total hip replacement at Cappagh Hospital and have been assessed by the Bone Bank Co-Ordinator. Harvesting: The bone is retrieved and harvested at the time of total hip replacement according to a strict protocol. Storage: The bone is stored in the “Quarantine” freezer at −80 degrees C for a minimum period of 180 days. Each specimen is subjected to a full technical review by the Bone Bank Co-Ordinator and Medical Director and only when results of screening confirmed negative, the bone designated suitable for “Issue Stock” freezer. Issue of Allografts: Bone is supplied for use, only after receiving full details of recipient to allow tracking. The results of the culture swab taken at the time of implantation and details of any post operative infection in recipients are forwarded to the bone bank. Results: From June 1996 to December 2003, 5089 Primary Total Hip Replacements done at Cappagh Hospital and 1921 (38%) femoral heads were harvested. 109 (5.7%) of grafts had initial positive swabs/chips and 22 of these were discarded because of second positive chips. 1457 femoral head grafts supplied to 876 recipients and were used in Revision Total Hip Replacement (60%), Spine Surgeries (15%), Revision Total Knee (12%), Fractures, Tumours, Foot and Ankle (12%). 6 swabs at the time of grafting in recipients grew Staphylococcus Epidermidis but no clinical infection reported in our follow-up system. To double check, we posted a questioner to all consultants with list and details of their recipient patients and only 2 cases of suspected grafts related infection reported. Discussion and Conclusion: Microbiological surveillance of bone grafts protect recipients from infection and is useful as a quality control of the process of bone banking (Farrington et al 1998). Our study showed contamination rate of 5.7%. Minimum infection rate post Revision Hip Replacement has been reported by Tomford in 1990, but after massive femoral allograft, infection has been reported 4% – 5% (Tomford 1990) and over 11% by Lord et al in 1988. Our experience showed only 2 cases in spite of strict follow-up protocol. We follow the policy of discarding the heavily contaminated grafts (Chapman 1992). The quality performance of a Bone Bank depend on a full time bone bank co-ordinator, identification of donors, retrieval and harvesting of grafts, blood and microbiological assessment, medical supervision for decisions about contaminated grafts, a strict follow-up protocol and a regular audit of bone bank (Ivory and Thomas 1993). We also suggest that regular correspondence to the consultant using the bone grafts will improve the accuracy of follow-up

Purpose: Prosthetic hip surgery (150,000 total hip arthroplasties in France including 10–12% revision procedures) have required the development of bone banks to have graft material readily available. Safety and tracability requirements have led to the disappearance of local banks and the creation of validated tissue banks. The French tissue bank (TBF), which received its official authorization from the AFSSAPS in January 2001, began operating in 1992, collecting femoral heads (FH) procured during hip arthroplasties. Material and methods: Material collection has increased steadily over the last five years. In 2002, 5004 FH were collected in 126 public or private centres. The number of FH which were rejected for regulatory, health (clinical and biological selection) and harvesting quality remained relatively stable around 20% from 1997 to 2000. Rejection for socioclincal reasons, which varied from 3 to 5%, included, in decreasing order, cancer, transfusion history, systemic disease and/or history of neurodegenerative disease, long-term corticosteroid treatment, and notion of infectious risk (mainly viral). Secondary rejection because regulatory tests could not be performed varied from 3 to 6% and included haemolysis, insufficient quantity for assay or preservation in the serum bank, ALAT assay impossible, serology suggestive of recent or former viral infection: HCV, HBV, HIV, HTLV. The FH underwent chemical treatment (viral and prion inactivation), mechanical treatment (production of bone shreads, cancellous blocks, wedges, whole heads, heads without neck), radiosterilisation and lyophylisation. Results: Sixty percent of the grafts were used for hip arthroplasty, mainly during revision procedures (80%) (1.4 grafts on average, whole heads and blocks and more recently shredded bone); 8.5% were used for knee arthroplasty and 11.5% (blocks) for spinal surgery, 11% for fractures (in decreasing order femur, distal tibia, tibial plateau, ankle, foot, shoulder, arm, other), 4% for nonunions, 5% for osteotomies (blocks or wedges). Conclusion: More and more grafts are used for osteotomy and spinal fusion procedures. Use of shredded bone is increasing. We are currently working on a cancellous bone paste combined with bone substitute

Purpose: We report our experience with acetabular reconstruction using cyropreserved bone bank hemipevli without a scaffold and total hip arthroplasty for major acetabular defects. Between 1985 and 1999, among 262 acetabular reconstructions requiring massive allografts using cryopre-served bone, 20 cases were performed with hemipelvi. Material and methods: Mean age of the population was 56 years. The acetabulum had been operated on a mean three times. The 20 defects corresponded to Paprosky grade IIIB or SOFCOT grade IV bone loss. Clinical and radiological review of the 20 hips was made at a mean five years after treatment. None of the patients was lost to follow-up. The overall Postel Merle d’Aubigné (PMA) score at last follow-up was 17 for preoperatively scores at D2, M4 and S3 respectively. The acetabular defects were major and poorly described by the conventional systems. For example, the mean height of the bony defects was about 10 cm measured from the base of the radiographic U and the superolateral rim of the remaining roof. Results: Globally, 13 patients had not required a reoperation at last follow-up. We had one postoperative death and two early displacements as well as two infections including one haematogenous infection. The Oakeschott criteria were used to analyse the review radiographs. Aseptic lysis of the graft was observed in five cases (generally around the 13th postoperative month) that required revision; a bone graft and a supporting ring were used in all cases because more bone stock was available than for the first revision. Among the 13 cases that did not require a new procedure, there were two with an ascended graft displacing the centre of rotation about 10 mm, followed by radiographic stability. The overall functional score for these 13 hemipelvi at last follow-up was 17 demonstrating the superior functional result compared with arthroplastic resection, the only alternative for such important loss of bone stock. It is not possible to implant a large non-cemented socket in these cases. Radiographic fusion was achieved, documented in 13 cases by the development of bony bridges or disappearance of the interface with oriented lines of force. Early graft resorption does not appear to occur when a metallic scaffold is associated (Garbuz). Discussion: In all, 19 hips still had their total arthroplasty at last follow-up (one patient with failure preferred trocahntero-iliac coaptation. Conclusion: Due to the inefficacy of alternative methods, this mode of restoration for major bone loss of the acetabular region (which facilitates secondary revision) appears to provide satisfactory results since the probability of preserving the prosthesis at a mean five years was slightly greater than 3/5. A stronger metallic scaffold may be the solution for the future

A radiation sterilisation dose (RSD) of 25 kGy is commonly recommended for sterilisation of allograft bone. However, the mechanical and biological performance of allograft bone is gamma dose-dependent. Therefore, this study aimed to apply Method 1 – ISO 11137–2: 2006 to establish a low RSD for frozen bone allografts. Two groups of allograft bones were used: 110 femoral heads (FH) and 130 structural and morselized bones (SMB). The method included the following stages: bioburden determination using 10 FHs and 30 SMBs; verification dose selection using table six in the ISO standard and bioburden; the verification dose was used to irradiate 100 samples from each group; then irradiated bone segments were tested for sterility. The criterion for accepting the RSD as valid is that there must be no more than two non-sterile samples out of 100. The radiation sterilisation dose is then established based on table five, ISO 11137– 2: 2006. The bioburden of both types of frozen allograft was zero. The verification dose chosen was 1.3 kGy. Two hundred bone segments were irradiated at 1.3 kGy. The average delivery gamma dose was 1.23 kGy (with minimum dose of 1.05 kGy maximum dose of 1.41kGy), which is acceptable according to the ISO standard. Sterility tests achieved 100% sterility. Accordingly, 11 kGy was established as a valid RSD for those frozen bone allografts. A reduction in the RSD from 25 kGy to 11 kGy will significantly improve bone allograft mechanical and biological performance because our data show that this dose level improves the mechanical toughness and osteoclast activity of the allograft by more than 10 and 100 percent, respectively, compared with bone allografts irradiated at 25 kGy. A low RSD of 11 kGy was established for allograft bones manufactured at Queensland Bone Bank by applying dose validation method 1 (ISO 11137.2-2006) that is internationally accepted

Purpose: We have used monoblock cryopreserved femoral heads for acetabular reconstruction without supporting material since 1985 for cemented total hip arthroplasty in patients with major acetabular defects. From 1985 to 1995, 140 reconstructions were performed. We present a prospective analysis of the clinical and radiological outcome at 10 years follow-up.

Material and methods: Mean age of the population was 61 years. Most of the patients had had two prior interventions. According to the SOFCOT classification, the 140 defects were: grade II 50%, grade III 35% and grade IV 15%.

The cryopreserved graft (femoral head bone bank) was used to reconstruct the acetabular defect. The graft was adapted to the size of the defect to fashion a congruent construct aimed at achieving primary stability. We did not use any supporting material in addition the primary osteosynthesis with one or two screws. A poly-ethylene cup was cemented in the graft. Most of the cement was applied onto the graft which was reamed to the size of the acetabulum. We retained a theoretical 6-year follow-up for review. All patients were seen for follow-up assessment using the Postel-Merle-d’Aubigné (PMA) clinical score and standard x-rays analysed according to the Oakeshott method. Kaplan-Meier survival curves were plotted taking change in status, revision for clinical failure as the endpoint.

Results: Mean overall follow-up was 8.5 years; it was 10 years for patients with an implant still in situ. Eight patients (5.7%) lost to follow-up were included in the series retained for analysis at mean 5-year follow-up. Thirty-five patients died during the follow-up period (25%). These patients had been followed for a mean four years before their death. Radiologically, cup tilt was not significantly altered over time. Conversely, the centre of the cup, measured from the U line, was not modified in the patients who died or in the group of living patients without revision at last follow-up. It was modified in the group of failure group: mean 28 mm postoperatively in the failure group reaching 39 mm at time of failure (ANOVA < 10-3). We had 26 failures (18%) which occurred at six years (mean); there was a peak at two years and another at nine years. Mean Kaplan-Meier survival was 13.5 years (95CI 12.5–14). The PMA clinical score improved from 3/5/3 (11) pre-operatively to 5.3/5.6/4.3 (15.2) at last follow-up.

Discussion: The overall results at 10 years in this series were globally satisfactory with a success rate above 70%. Failures were related to radiologically demonstrated graft compression with ascension of the centre of the cup measured from the U line. Comparing these results with data in the literature shows an improvement over the Harris series (7-year follow-up in a small group of 48 patients).

Conclusion: This method of acetabular reconstruction reserved for major bony defects has provided a 73% rate of success at ten years.

Paediatric musculoskeletal (MSK) disorders often produce severe limb deformities, that may require surgical correction. This may be challenging, especially in case of multiplanar, multifocal and/or multilevel deformities. The increasing implementation of novel technologies, such as virtual surgical planning (VSP), computer aided surgical simulation (CASS) and 3D-printing is rapidly gaining traction for a range of surgical applications in paediatric orthopaedics, allowing for extreme personalization and accuracy of the correction, by also reducing operative times and complications. However, prompt availability and accessible costs of this technology remain a concern. Here, we report our experience using an in-hospital low-cost desk workstation for VSP and rapid prototyping in the field of paediatric orthopaedic surgery. From April 2018 to September 2022 20 children presenting with congenital or post-traumatic deformities of the limbs requiring corrective osteotomies were included in the study. A conversion procedure was applied to transform the CT scan into a 3D model. The surgery was planned using the 3D generated model. The simulation consisted of a virtual process of correction of the alignment, rotation, lengthening of the bones and choosing the level, shape and direction of the osteotomies. We also simulated and calculated the size and position of hardware and customized massive allografts that were shaped in clean room at the hospital bone bank. Sterilizable 3D models and PSI were printed in high-temperature poly-lactic acid (HTPLA), using a low-cost 3D-printer. Twenty-three operations in twenty patients were performed by using VSP and CASS. The sites of correction were: leg (9 cases) hip (5 cases) elbow/forearm (5 cases) foot (5 cases) The 3D printed sterilizable models were used in 21 cases while HTPLA-PSI were used in five cases. customized massive bone allografts were implanted in 4 cases. No complications related to the use of 3D printed models or cutting guides within the surgical field were observed. Post-operative good or excellent radiographic correction was achieved in 21 cases. In conclusion, the application of VSP, CASS and 3D-printing technology can improve the surgical correction of complex limb deformities in children, helping the surgeon to identify the correct landmarks for the osteotomy, to achieve the desired degree of correction, accurately modelling and positioning hardware and bone grafts when required. The implementation of in-hospital low-cost desk workstations for VSP, CASS and 3D-Printing is an effective and cost-advantageous solution for facilitating the use of these technologies in daily clinical and surgical practice

Introduction: Filling of bone defects is a significant challenge in Orthopaedic Surgery. Human fresh-frozen allograft is still the most effective bone graft substitution material («gold standard»), guaranteeing all essential biological and physiochemical demands (osteogenic, osteoinductive, and osteoconductive) when the necessary amount of autologous bone is not available. Using donor screening recommendations, more than 50 % of potential donors have to be excluded. With increasing incidence for revision hip surgery and especially acetabular reconstructions, a hospital associated bone bank has difficulties meeting demand. The aim of this study is to evaluate the balance and resource utilisation of a hospital associated bone bank for fresh-frozen allografts and the correlation to commercial alternatives regarding cost effectiveness. Method: For evaluation of resource utilisation and cost effectiveness of a hospital associated bone bank, all donation processes and the details of allograft use were analysed and summarized within a period of 30 months. Given the increasing disproportion of demand and availability, the reasons for exclusion, especially for exclusion during the preservation period, were carefully scrutinized. The costs of installation and maintenance of the bone bank, as well as all costs in the screening process were balanced to calculate the «per head»-price. The results were compared to commercial alternatives. Results: Within the period of evaluation 632 femoral heads were available for donation. Through the screening process 359 femoral heads (56.8%) met at least one criterion for exclusion. At the end of the observation period of six months and after HIV retesting, 246 allografts met all criteria for use. The mean period between inclusion in the bone bank and release was 10.9 5.0 months (range 6.0–30.8). 50.8% of released allografts (125 heads) were used in revision arthroplasty. In spine surgery 83 allografts (33.7%) were implanted in spinal fusions and for cage filling during vertebral body replacement. Thirty-two grafts (13.0%) were used in miscellaneous surgeries with minor bone demand. The costs per donation were 92, with personnel costs the price per head was 140. The price range for commercial alternatives starts at 100 for 1 cm. Conclusion: A hospital associated bone bank for fresh-frozen allografts is still an effective and cost effective method to maintain material for bone defect filling. To meet demand, information and communication to donors has to be increased to get the HIV-retests. Additionally, division of donations into smaller portions helps to decrease waste in surgeries where less bone is required

Introduction and Objective. In recent years, along with the extending longevity of patients and the increase in their functional demands, the number of annually performed RSA and the incidence of complications are also increasing. When a complication occurs, the patient often needs multiple surgeries to restore the function of the upper limb. Revision implants are directly responsible for the critical reduction of the bone stock, especially in the shoulder. The purpose of this paper is to report the use of allograft bone to restore the bone stock of the glenoid in the treatment of an aseptic glenoid component loosening after a reverse shoulder arthroplasty (RSA). Materials and Methods. An 86-years-old man came to our attention for aseptic glenoid component loosening after RSA. Plain radiographs showed a complete dislocation of the glenoid component with 2 broken screws in the neck of glenoid. CT scans confirmed the severe reduction of the glenoid bone stock and critical bone resorption and were used for the preoperative planning. To our opinion, given the critical bone defect, the only viable option was revision surgery with restoration of bone stock. We planned to use a bone graft harvested from distal bone bank femur as component augmentation. During the revision procedure the baseplate with a long central peg was implanted “on table” on the allograft and an appropriate osteotomy was made to customize the allograft on the glenoid defect according to the CT-based preoperative planning. The Bio-component was implanted with stable screws fixation on residual scapula. We decided not to replace the humeral component since it was stable and showed no signs of mobilization. Results. The new bio-implant was stable, and the patient gained a complete functional recovery of the shoulder. The scheduled radiological assessments up to 12 months showed no signs of bone resorption or mobilization of the glenoid component. Conclusions. The use of bone allograft in revision surgery after a RSA is a versatile and effective technique to treat severe glenoid bone loss and to improve the global stability of the implant. Furthermore, it represents a viable alternative to autologous graft since it requires shorter operative times and reduces graft site complications. There are very few data available regarding the use of allografts and, although the first studies are encouraging, further investigation is needed to determine the biological capabilities of the transplant and its validity in complex revisions after RSA

Aims: The purpose of this study is to answer the question, whether local femoral head bone banks are still suitable and how to manage and make them safe. Methods: Surgical donors (THR) are selected by medical history, clinical examination and internationally standardized serological testing. Femoral heads are prucured during THR under OR-sterile conditions. Two different viral and bacterial inactivation methods are performed regularly. Either heads are devided into halves and then autoclaved in an open sterile hot and cold resistant box (121°C,20min,1,4 bar) or entirely processed in a closed sterile box in a water bath (80°C,100min-Marburger bone bank system) and stored in a refrigerator (−80°C). Validation of inactivation has been performed using measurement of the temperature in the center of the bones. Results: 867 bone allografts processed in the described method have been transplanted between 1993 and 2001 in our hospital. Autoclaved grafts have been used in limited bone defects with good surrounding bone stock quality. Water bath treated entire femoral heads have been used in total joint revision surgery. Temperature measurement in autoclaved bones confirmed the biological validation performed by Ph. Chiron (EAMST 1993). Water bath treatment has previously been validated. These grafts proved to be safe, effective and affordable and avoid the higher infection risks of bones procured from organ donors. By the described method we are able to meet a big part of the bone allograft demand in our institution. Conclusions: Using the described method local femoral head bone banks can procure safe and reasonable bone allografts from living surgical donors (THR). Allografts from organ donors cause higher risks and should be used where structural grafts are needed

Introduction. Cancellous and cortical bone used as a delivery vehicle for antibiotics. Recent studies with cancellous bone as an antibiotic carrier in vitro and in vivo showed high initial peak concentrations of antibiotics in the surrounding medium. However, high concentrations of antibiotics can substantially reduce osteoblast replication and even cause cell death. Objectives. To determine whether impregnation with gentamycine impair the incorporation of bone allografts, as compared to allografts without antibiotic. Materials and method. Seventy two healthy rabbits (24 rabbits in each group) were used for this study. Bone defects (3-mm diameter, 10-mm depth) were created in the femur. Human femoral head prepared according to the Marburg bone bank system was used as bone allograft. In the experimental groups, in 1 group - the defects were filled with bone allografts, in 2 group – Perforated Gentamycin-impregnated bone allografts. The control group did not receive any filling. The animals were killed after 14, 30 and 60 days. Evaluations consisted of X-ray plain radiography, histology at 14-, 30- and 60-days post-surgery. Results. Active osteoblast activity and active formation of new bones were detected around the defect area in all groups, but the amount of new bone formation was greater in the experimental groups than the control group. We found no statistically significant differences in the rate of bone formation between 1 and 2 groups at 14, 30 and 60 days in any of the parameters studied. X-ray results showed no significant difference in bony callus formation around allografts in 1 and 2 groups. In contrast, no significant callus formation was observed in the control group. Conclusion. The use of gentamycin-impregnated bone allografts may be of value in procedures performed at the site of osteomyelitis which require a second stage reconstruction with impacted bone grafting techniques

This study assessed factors responsible for exclusion of patients from bone donation at primary hip arthroplasty in order to improve bone banking. Fifty-five patients underwent screening in preoperative clinics assessing their suitability for femoral head donation. Records at the bone bank were then reviewed post operatively to check whether bone had been harvested from these individuals during surgery. Overall, 95% of the patients screened did not proceed to bone banking. After the initial screening stage 60% of patients were excluded. The majority of exclusions (70%) were unacceptable as donors because of their potential risk of transmission of disease to recipients. Although 40% were consented for donation, femoral heads from only 5% were harvested and sent for storage in the bone bank during hip arthroplasty. Orthopaedic surgeons must take an active part in bone banking and alternative sources of bone grafts require exploration in the future to meet the increasing demand

Introduction The need for bone graft has increased in recent years partly due to the greater numbers of revision hip arthroplasties being performed secondary to the increasing life expectancy in the UK. Method Our study prospectively reviewed the practice of bone banking at Portsmouth Hospital NHS Trust to look into the various factors responsible for exclusion of patients from donation of bone. All 55 patients under-went screening in a preoperative assessment clinic using a standard proforma to assess their suitability for femoral head donation during the course of their primary hip arthroplasty and records at the bone bank were then reviewed post operatively to check whether bone had been harvested from these individuals during surgery. Results 95% of the patients screened did not proceed to bone banking. After the initial screening stage 33 patients (60%) were excluded due to a variety of reasons. The majority of those excluded (23 patients) were not accepted as donors because of the potential risk of transmission of disease to their recipients. Although 22 patients (40%) were consented for allograft donation, femoral heads from only 3 patients (5%) were harvested and sent for storage in the bone bank during hip arthroplasty. Discussion The harvesting of viable bone stock was shown to be poorly utilised in our study. Orthopaedic surgeons must take an active part in bone banking and alternative sources of bone grafts need to be explored in the future to meet the increasing demand

Femoral head allograft bone used in complex orthopaedic surgery may transmit infection from donor to recipient. In order to minimise the risk all donors are serologically screened for Hepatitis B and C, HIV, HTLV, and syphilis at the time of donation and again at 6 months post-donation. Culture swabs are taken from the acetabulum and femoral head for 48 hour anaerobic and aerobic culture, and a sample of bone is incubated for 5 days in enrichment broth culture. We have audited the culture results and screening tests performed in our bone bank from 2000 to 2005 inclusive. 1,528 allografts were received of which we had to discard 52 (3.4%) because of either positive cultures or serology. The vast majority of the positive cultures were due to S. epidermidis (30/43). All cultures were bacteria one might expect to find as normal skin flora. 3 patients had positive hepatitis C serology and 6 were syphilis EIA positive. In May 2004 we decided in line with National Transfusion Guidelines for blood donation, to exclude donors who had had a blood transfusion since 1980 to mini-mise the risk of transmission of CJD. This and the opening of an Independent Treatment Centre (ITC) in our area drastically limited the number of possible donors to our bone bank. There was a significant reduction in the number of femoral heads received in 2004 and 2005 when compared with years 2000-2003 (p = < 0.00001). We conclude that negligible numbers of femoral head allografts are lost due to our serological and microbio-logical screening tests. However measures introduced to limit the theoretical transmission of CJD via a bone allograft and the opening of a local ITC have had a huge impact on the number of potential donors available to us. To date the CJD prion has not been isolated from bone, but there have been 3 reported cases of transmission of infection by blood transfusion. We fear that the imminent introduction of a serological test for CJD will limit the number of possible bone donors even further

Introduction: With the growing number of primary knee arthroplasties, the number of revision operations is also increasing. The large number of unicondylar replacements carried out in the 1980’s, due to lack of modern total condylar implants, grant the revision techniques an outstanding significance in Hungary. One of the main issues of modern revision techniques is the management of bone defects, which can be solved by different methods documented in literature. Aim of study: The aim of our study was to investigate the success and feasibility of the various defect management techniques by evaluating the results of revision knee prosthetic surgeries carried out at our clinic. Patients and methods: Femoral and tibial bone defects had to be solved with revision surgeries in 35 cases, all performed due to aseptic loosening of uni- and total condylar prostheses implanted earlier. For filling of bone defects, metal augmentation of the prostheses was applied in 9 cases, allografts from bone bank were used in 11 cases, own cancellous bone was applied in 20 cases. Results were prospectively analysed with the help of the knee society rating system, with an average follow-up of two and a half years. Results: Revision interventions were successful in 34 cases, detailed results are revealed in the presentation, complemented with case presentations. In a single case, repeated intervention surgery is indicated due to disorganisation of the structural allograft and the resulting loosening of the tibial component. Conclusion: The success of the various bone replacement techniques, completed with adequate indication could be proven in all cases. The unsuccessful case proved that allograft incorporation should be supported by appropriate stem augmentation of the tibial component. In order to perform successful revision knee arthroplasty, we consider it fundamentally important to have a wide variety of allografts from bone bank and a modern knee prostheses system application already during primary implantations

Aims. To report the outcome observed in 34 dogs with non metastatic distal radial osteosarcoma (OSA) treated by a combination of adjuvant chemotherapy and limb-sparing surgery. Limb-sparing procedures were based on the use of a frozen bone cortical allograft (group A; 18 cases) and of a pasteurised tumoral autograft (group B; 16 cases), respectively. Methods. In group A, limb-sparing procedure was performed using a fresh-frozen cortical allograft from a bone bank. In the group B, the bone graft was realized from the excised tumoral segment after its pasteurisation at 65A1C for 40 minutes. Adjuvant chemotherapy (cisplatin or cisplatin and doxorubicin) was administered in all dogs. Results. In group A, mean and median survival times were 478-266 days, respectively (range 80–2611 days). Overall survival was 78% at 6 months, 35% at 12 months, 23% at 18 months and 19% at 24 months. Lung metastasis occurred in 10 cases (55%). Observed complications were local recurrence (28%), graft infection (39%) and implant failure (11%). In group B, mean and median survival times were 533-368 days, respectively (range 137–1944 days). Overall survival was 100% at 6 months, 57% at 12 months, 45% at 18 months and 20% at 24 months. Metastasis were observed in 7 dogs (44%). Complications were local recurrence (12%), graft infection (44%) and implant failure (19%). Limb function was good in 72% (group A), and 92% (group B) of the dogs, respectively. Conclusions. Limb-sparing techniques with bone grafts represent an alternative to amputation in the treatment of selected cases of distal radial osteosarcoma. Limb sparing techniques are not free of complication (infection, implant failure, recurrence) if compared to amputation. The latter represents the elective option in most cases of appendicular OSA and is usually free of complication. Comparing the two treatment groups, pasteurised bone autograft derived from the tumoral bone segment represents an effective alternative to cortical bone allograft coming from a bone bank, considering the difficulties encountered in finding donor dogs and national legal limitations on establishing a canine cortical bone graft bank. Alternative limb sparing procedures (metallic implant, Ilizarov) will be also discussed

Femoral revision after cemented total hip arthroplasty (THA) might include technical difficulties, following essential cement removal, which might lead to further loss of bone and consequently inadequate fixation of the subsequent revision stem. Bone loss may occur because of implant loosening or polyethylene wear, and should be addressed at time of revision surgery. Stem revision can be performed with modular cementless reconstruction stems involving the diaphysis for fixation, or alternatively with restoration of the bone stock of the proximal femur with the use of allografts. Impaction bone grafting (IBG) has been widely used in revision surgery for the acetabulum, and subsequently for the femur in Paprosky defects Type 1 or 2. In combination with a regular length cemented stem, impaction grafting allows for restoration of femoral bone stock through incorporation and remodeling of the proximal femur. Cavitary bone defects affecting the metaphysis and partly the diaphysis leading to a wide femoral canal are ideal indications for this technique. In case of combined segmental-cavitary defects a metal mesh is used to contain the defect which is then filled and impacted with bone grafts. Cancellous allograft bone chips of 2 to 4 mm size are used, and tapered into the canal with rods of increasing diameters. To impact the bone chips into the femoral canal a dummy of the dimensions of the definitive cemented stem is inserted and tapped into the femur to ensure that the chips are firmly impacted. Finally, a standard stem is implanted into the newly created medullary canal using bone cement. To date several studies from Europe have shown favorable results with this technique, with some excellent long-term results reported. Advantages of IBG include the restoration of the bone stock in the proximal femur, the use of standard length cemented stems and preserving the diaphysis for re-revision. As disadvantages of the technique: longer surgical time, increased blood loss and the necessity of a bone bank can be mentioned

Fresh-frozen allograft bone is frequently used in orthopaedic surgery. We investigated the incidence of allograft-related infection and analysed the outcomes of recipients of bacterial culture-positive allografts from our single-institute bone bank during bone transplantation. The fresh-frozen allografts were harvested in a strict sterile environment during total joint arthroplasty surgery and immediately stored in a freezer at −78° to −68° C after packing. Between January 2007 and December 2012, 2024 patients received 2083 allografts with a minimum of 12 months of follow-up. The overall allograft-associated infection rate was 1.2% (24/2024). Swab cultures of 2083 allografts taken before implantation revealed 21 (1.0%) positive findings. The 21 recipients were given various antibiotics at the individual orthopaedic surgeon's discretion. At the latest follow-up, none of these 21 recipients displayed clinical signs of infection following treatment. Based on these findings, we conclude that an incidental positive culture finding for allografts does not correlate with subsequent surgical site infection. Additional prolonged post-operative antibiotic therapy may not be necessary for recipients of fresh-frozen bone allograft with positive culture findings. Chang Gung Medical Foundation