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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aho AJ, Hirn M, Aro HT et al (1998) Bone bank service in Finland. Experience of bacteriologic, serologic and clinical results of the Turku Bone Bank 1972–1995. Acta Orthop Scand 69(6):559–565
Bundesärztekammer WB (2001) Richtlinien zum Führen einer Knochenbank. Dtsch Ärztebl 98(15):A1011–A1016
CDC (1988) Transmission of HIV through bone transplantation: case report and public health recommendations. MMWR 37:595–599
Chapman PG, Villar RN (1992) The bacteriology of bone allografts. J Bone Joint Surg Br 74(3):398–399
Chiew YF, Theis JC (2007) Comparison of infection rate using different methods of assessment for surveillance of total hip replacement surgical site infections. ANZ J Surg 77(7):535–539
Chiu CK, Lau PY, Chan SW et al (2004) Microbial contamination of femoral head allografts. Hong Kong Med J 10(6):401–405
Conrad EU, Gretch DR, Obermeyer KR et al (1995) Transmission of the hepatitis-C virus by tissue transplantation. J Bone Joint Surg Am 77(2):214–224
Deijkers RL, Bloem RM, Petit PL et al (1997) Contamination of bone allografts: analysis of incidence and predisposing factors. J Bone Joint Surg Br 79(1):161–166
EU (2004) Directive 2004/23/EC of the European Parliament and the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells. Off J Eur Union L102:58
Floren M, Kappe T, Reichel H (2007) Effektivitaetsanalyse einer klinikinternen allogenen Knochenbank [Analysis of the effectiveness of an internal hospital bone bank.]. Orthopade 36(7):667–672
Halliday BR, English HW, Timperley AJ et al (2003) Femoral impaction grafting with cement in revision total hip replacement. J Bone Joint Surg Br 85(6):809–817
Hart MM, Campbell ED Jr, Kartub MG (1986) Bone banking. A cost effective method for establishing a community hospital bone bank. Clin Orthop Relat Res 206:295–300
Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274
Hou CH, Yang RS, Hou SM (2005) Hospital-based allogenic bone bank—10-year experience. J Hosp Infect 59(1):41–45
Ivory JP, Thomas IH (1993) Audit of a bone bank. J Bone Joint Surg Br 75(3):355–357
Liu JW, Chao LH, Su LH et al (2002) Experience with a bone bank operation and allograft bone infection in recipients at a medical centre in southern Taiwan. J Hosp Infect 50(4):293–297
Mankin HJ, Doppelt S, Tomford W (1983) Clinical experience with allograft implantation. The first ten years. Clin Orthop Relat Res 174:69–86
Mankin HJ, Gebhardt MC, Jennings LC et al (1996) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res 324:86–97
Meermans G, Roos J, Hofkens L et al (2007) Bone banking in a community hospital. Acta Orthop Belg 73(6):754–759
Nather A, David V (2007) Femoral head banking: NUH tissue bank experience. Orthopedics 30(4):308–312
Pruss A, von Versen R (2007) Influence of European regulations on quality, safety and availability of cell and tissue allografts in Germany. Handchir Mikrochir Plast Chir 39(2):81–87
Pruss A, Seibold M, Benedix F et al (2003) Validation of the “Marburg bone bank system” for thermodisinfection of allogenic femoral head transplants using selected bacteria, fungi, and spores. Biologicals 31(4):287–294
Pruss A, Knaepler H, Katthagen BD et al (2005) Auswirkungen der EU-Geweberichtlinie 2004/23/E.G auf deutsche Knochenbanken [Consequence of European Directive 2004/23/EC for bone banks in Germany]. Orthopade 34(11):1160–1168
Schreurs BW, Thien TM, de Waal Malefijt MC et al (2003) Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis: three to fourteen-year follow-up. J Bone Joint Surg Am 85(4):647–652
Segawa H, Tsukayama DT, Kyle RF et al (1999) Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 81(10):1434–1445
Sommerville SM, Johnson N, Bryce SL et al (2000) Contamination of banked femoral head allograft: incidence, bacteriology and donor follow up. Aust N Z J Surg 70(7):480–484
Sutherland AG, Raafat A, Yates P et al (1997) Infection associated with the use of allograft bone from the north east Scotland Bone Bank. J Hosp Infect 35(3):215–222
Tomford WW (2000) Bone allografts: past, present and future. Cell Tissue Bank 1(2):105–109
Tomford WW, Starkweather RJ, Goldman MH (1981) A study of the clinical incidence of infection in the use of banked allograft bone. J Bone Joint Surg Am 63(2):244–248
Tomford WW, Thongphasuk J, Mankin HJ et al (1990) Frozen musculoskeletal allografts. A study of the clinical incidence and causes of infection associated with their use. J Bone Joint Surg Am 72(8):1137–1143
Winter JM, Cowie AI, Wood DJ et al (2005) Musculoskeletal tissue banking in Western Australia: review of the first ten years. ANZ J Surg 75(8):665–671
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kappe, T., Cakir, B., Mattes, T. et al. Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors. Cell Tissue Bank 11, 253–259 (2010). https://doi.org/10.1007/s10561-009-9140-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10561-009-9140-5