Infection and utilization rates of bone allografts in a hospital-based musculoskeletal tissue bank in north India

Exploring the Role of Intraoperative Positive Culture of Allograft Bone in Subsequent Postoperative Infections among Donors and Recipients in Bone Bank Processing

BACKGROUND

Allografts have been frequently used in orthopedic procedures. The purposes of this study were to evaluate the discard rates and bacterial contamination of a bone bank, and to assess the clinical outcomes of recipients with bacterial culture-positive donor allografts.

METHODS

We retrospectively reviewed 1764 allografts which were harvested from living donors and stored in a bone bank from 2018 to 2022. The donors whose allografts displayed bacterial contamination at retrieval of the primary hip or knee arthroplasty were followed for microbiology and subsequent prosthetic joint infection analysis. The infected pathogens, antibiotic treatment and subsequent infection were reviewed for the intraoperative positive culture group.

RESULTS

The discard rate was 17%, and the bacterial contamination rate of bone retrieval was 2.15%. Thirty-eight allografts at retrieval displayed confirmed bacterial growth, and 37 patients did not reveal infective signs at 6 months follow-up. A total of 1464 allografts were stored and implanted, among which 28 allografts (1.91%) were confirmed to be positive for bacterial growth and 13 cases (0.89%) were confirmed as surgical site infections.

CONCLUSIONS

Our results validate the suggestion that our bone bank system performs good quality monitoring to eliminate the risk of dissemination of viral and bacterial diseases and to decrease surgical site infection after allograft implantation. By ensuring aseptic conditions and contamination-reducing strategies during harvesting and thawing, the allografts can be safely stored and implanted while limiting bacterial contamination. Our findings confirm that the intraoperative positive cultures of allografts did not contribute to subsequent postoperative surgical site infection in donors and recipients.

A, Ajoy SM. Fresh Fractures: A New Indication for Use of Bone Allografts-A 10-Year Data Analysis

Background

Tissue banking includes the process starting from procurement to the distribution and usage of allograft tissues. The use of bone bank in orthopaedics is not widely seen. Our objective is to describe the 10-year allograft donor and recipient data from a fully functioning tissue bank in India, analyse the types of grafts used, indications and demand for various grafts. This will show the need for a tissue bank in a tertiary care orthopaedic setup.

Methods

Analysis of donor and recipient data for allografts of a tissue bank in an Indian tertiary care setup was done from 2012 to 2022. The number of grafts procured and used were analysed. The recipient and donor sites were also analysed.

Results

In 10 years, the tissue bank provided 2776 grafts and received 1962 donations. Slices procured after total knee replacements were the most commonly used allografts (28.03%). Acute fracture with bone loss or severe comminution (23.11%) being the most common indication of bone grafting was a major result of our study. Among these, proximal tibia (27.79%) was the most frequent recipient site. Tissue bank has also served patients in neurosurgery, ophthalmology, oromaxillofacial surgery, otorhinolaryngology, urology and wound care.

Conclusion

A tissue bank is a useful setup in tertiary care orthopaedic hospitals. Allografts were most widely used for acute trauma management. Allografts provide large graft quantity and reduce surgical time. Hence a tissue bank is not only an asset to the establishment but also to the surrounding hospitals, to which the grafts can be supplied.

Need, Strategies and Requirements in the Medical System for Bone Banks: A Review Article

An orthopedic bone bank's creation and management is a challenging procedure where medical organization and legal requirements interact. There are no formal regulations for the management and organization of an orthopedic bone bank in the Netherlands or any other nation in Europe. The recently revised "law of security and quality for utilizing human materials in the Netherlands establishes guidelines for the technical and administrative elements of using human tissue and cells. The bone bank's processes involve a rigorous questionnaire for choosing donors, a complete bacteriological, histological, and serological examination, as well as industry-standard, practices for registering, processing, preserving, distributing, and storing bone allografts. This article explains how an approved bone bank is run, and it may be used as a suggestion for formal regulation or as a model for additional orthopedic bone banks in Europe. Osseous graft manufacture, testing, packing, storage, and transportation are all handled by bone banks. Their primary responsibility is to guarantee the transplants' biological characteristics and microbial cleanliness by legal and quality criteria. All orthopedic surgeons face the challenge of reconstructing bone defects; to address this issue, there are several methods, including the use of autografts, allografts, and bone substitutes to enhance and speed bone recovery. Although autografts have superior biological qualities, their volume is constrained and they are linked to donor site morbidity. Allografts are readily accessible, however, there are still worries about the possibility of infections, and they lack osteosarcoma qualities.