Clostridium Infections Associated with Musculoskeletal-Tissue Allografts

Kainer, Marion A.; Linden, Jeanne V.; Whaley, D N; Holmes, Harvey T; Jarvis, William R.; Jernigan, Daniel B.; Archibald, Lennox K.

doi:10.1056/nejmoa023222

Cited by 240 publications

(140 citation statements)

References 21 publications

(18 reference statements)

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“…The medullary canal was cleaned using pressurized distilled water, and the bones were soaked in 70% ethanol for 1 hour to sterilize and defat the bone. This sequence is similar to that used for human allografts [9,15,26]. The weight and displacement volume of each bone was measured to determine its bulk density.…”

Section: Methodsmentioning

confidence: 99%

Bisphosphonate Delivery to Tubular Bone Allografts

DiResta

Manoso

Naqvi

et al. 2008

Clin Orthop Relat Res

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Large structural allografts used for reconstruction of bone defects after revision arthroplasty and tumor resection fracture up to 27% of the time from osteolytic resorption around the fixation screw holes and tendon or ligament attachment sites. Treating structural allografts before implantation with bisphosphonates may inhibit local osteoclastic processes and prevent bone resorption and the development of stress risers, thereby reducing the long-term fracture rate. Taking advantage of allografts' open-pore structure, we asked whether passive soaking or positive-pressure pumping was a more efficient technique for delivering bisphosphonates. We treated matched pairs of ovine tibial allografts with fluids containing Tc-99m pamidronate and toluidine blue stain to facilitate indicator distribution analysis via microSPECT-microCT imaging and light microscopy, respectively. Surfactants octylphenoxy polyethoxy ethanol or beractant were added to the treatment fluids to reduce flow resistance of solutions pumped through the allografts. Indicator distribution after 1 hour of soaking produced a thin ring around periosteal and endosteal surfaces, while pumping for 10 minutes produced a more even distribution throughout the allograft. Flow resistance was reduced with octylphenoxy polyethoxy ethanol but unaffected with beractant. Pumped allografts displayed a more homogeneous indicator distribution in less time than soaking while surfactants enhanced fluid movement.

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Section: Methodsmentioning

confidence: 99%

Bisphosphonate Delivery to Tubular Bone Allografts

DiResta

Manoso

Naqvi

et al. 2008

Clin Orthop Relat Res

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“…Clostridium contamination risk increases with the length of time between donor death and procurement [50,51]. Safety guidelines established by the American Association of Tissue Banks (AATB) advocate donor screening, extensive serologic, bacterial, and viral testing; procurement and storage requirements; and graft quarantine until negative testing results are ensured [52].…”

Section: Risks and Complicationsmentioning

confidence: 99%

The use of osteochondral allografts in the management of cartilage defects

Demange

Gomoll

2012

Curr Rev Musculoskelet Med

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Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.

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“…The risk of infection by Clostridium increases proportionally to the elapsed time the time betweendonor death and tissue removal (35,36) . These risks are higher in the United States, as the majority of tissues are obtained from the death verification services, equipped with a tissue procurement room.…”

Section: Risks and Complicationsmentioning

confidence: 99%