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

Abstract

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.

Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review

“…2 The rate of positive intraoperative bone allograft culture in our series was 4.3%, consistent with rates reported in other centres. 7,9,10,12,15 Furthermore, subse quent postoperative infection following a positive intraop erative positive allograft culture was rare, occurring in 2 of 37 (5%) patients in our series. Importantly, during our 4year study period, no postoperative infection could be linked to a positive allograft bone culture.…”

“…1,2,4,6,7,9,12,15,20,24,25 Several studies examining the link between allograft bone and postoperative infection have cited various results, some attributing postoperative infection to allograft bone 2,6 and others to infection rates inherent with these often more complex procedures. 2,7,9,10,20 Postoperative infections in these cases are devastating complications and can be diffi cult to manage. Avoidance of infection is of the utmost importance.…”

“…Previous studies are small, singlecentre reviews, most of which concluded that cases of postopera tive infection could not be clearly linked with positive intraoperative allograft bone cultures at initial sur gery. 7,9,10,15,20,27 In a retrospective study by Van de Pol and colleagues, 9 48 of 426 patients receiving allograft bone were found to have positive intraoperative cultures. Three of these patients went on to experience significant postoper ative infections; however, only 1 patient was found to have the same organism isolated from the original allograft cul ture.…”

“…4,7,9,[11][12][13] Although some studies comment that cases of positive cul ture taken at the time of implantation went on to develop wound infections, 2,6 most studies suggest that these posi tive cultures do not correlate with postoperative infections and that the organisms isolated in the postoperative infec tion are only rarely the same as those isolated in the intra operative allograft culture. 9,10,12,14,15 It is difficult to apply these results to all populations, as national policies for handling allograft bone differ.…”

Biofilm formation by staphylococci on fresh, fresh-frozen and processed human and bovine bone grafts

“…Autologous cancellous bone grafts are typically harvested from the iliac crest or the distal radius and transplanted as fresh bone grafts during the same operation (De Long et al, 2007). Alternatively, allogeneic cancellous bone grafts can be harvested from femoral heads during primary hip replacement surgery and stored as fresh-frozen bone grafts in a bone bank (Van de Pol et al, 2007;Kappe et al, 2009). Another strategy to fill bone defects is the use of processed cancellous bone grafts (human or bovine) or synthetic/artificial bone grafts such as β-tricalcium phosphate (β-TCP) or hydroxyapatite (HA) (Bohner, 2010).…”