Use of Structural Allograft and Post-Surgical Infections
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Published:
Feb 14, 2022
Keywords:
Structural allograft, bone bank, infection, complications
Main Article Content
Abstract
The use of allografts carries the risk of various complications. Among the most frequent is infection. An important risk factor for infection with the use of bone grafts is the transmission of germs through the graft itself. Our objectives are to determine if there is a relationship between possible contamination of the grafts from this bank and postoperative infections; demonstrate how the proper donor selection, procurement, and processing of the graft decrease the rate of contamination; and report other complications relatedto the quality of the graft.
Materials and Methods: We selected patients who received structural bone grafts from our bank.All grafts were microbiologically studied. A review of the health records, anamnesis, physical examination, and radiographs was performed to evaluate infection and other complications. The ISOLS Osseointegration Scale was used to asses the consolidation of the grafts.
Results: No graft contamination was detected. One case (7.7%) of infection by carbapenemase-producing Klebsiella pneumoniae (KPC) and 3 cases (23%) of nonunion were identified. Consolidation was good to excellent in 77% of cases, satisfactory in 8%, and poor in 15%. No other complications were found.
Conclusion: There is a risk for infection transmission with structural allograft. Regulated donor selection criteria and control of bone bank procedures reduce the risk of infection due to graft contamination and other complications related to graft quality.
Materials and Methods: We selected patients who received structural bone grafts from our bank.All grafts were microbiologically studied. A review of the health records, anamnesis, physical examination, and radiographs was performed to evaluate infection and other complications. The ISOLS Osseointegration Scale was used to asses the consolidation of the grafts.
Results: No graft contamination was detected. One case (7.7%) of infection by carbapenemase-producing Klebsiella pneumoniae (KPC) and 3 cases (23%) of nonunion were identified. Consolidation was good to excellent in 77% of cases, satisfactory in 8%, and poor in 15%. No other complications were found.
Conclusion: There is a risk for infection transmission with structural allograft. Regulated donor selection criteria and control of bone bank procedures reduce the risk of infection due to graft contamination and other complications related to graft quality.
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How to Cite
Jorge, F. D., Varaona, J. M., & Basso, M. (2022). Use of Structural Allograft and Post-Surgical Infections. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(1), 23-33. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1138
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Clinical Research
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References
1. Sims L, Kulyk P, Woo A. Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review. Can J Surg 2017;60(2):94-100. https://doi.org/10.1503/cjs.008016
2. Zamborsky R, Svec A, Bohac M, Kilian M, Kokavec M. Infection in bone allograft transplants. Exp Clin Transplant
2016;14(5):484-90. PMID: 27733106
3. Rogers BA, Sternheim A, De Iorio M, Backstein D, Safir O, Gross AE. Proximal femoral allograft in revision hip
surgery with severe femoral bone loss: a systematic review and metaanalysis. J Arthroplasty 2012;27(6): 829-36.
https://doi.org/10.1016/j.arth.2011.10.014
4. Aponte-Tinao LA, Ritacco LE, Albergo JI, Ayerza MA, Muscolo DL, Farfalli GL. The principles and applications
of fresh frozen allografts to bone and joint reconstruction. Orthop Clin North Am 2014;45(2):257-69.
https://doi.org/10.1016/j.ocl.2013.12.008
5. Lemos Azi M, Aprato A, Santi I, Kfuri M Jr, Masse A, Joeris A. Autologous bone graft in the treatment of posttraumatic bone defects: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016;17(1):465.
https://doi.org/10.1186/s12891-016-1312-4
6. Mikhael MM, Huddleston PM, Nassr A. Postoperative culture positive surgical site infections after the use of
irradiated allograft, nonirradiated allograft, or autograft for spinal fusion. Spine 2009;34(22):2466-8.
https://doi.org/10.1097/BRS.0b013e3181b1fef5
7. Varaona JM. Banco de Tejido Óseo: Pautas para un funcionamiento eficiente y seguro. Tesis de Doctorado en
Medicina. Universidad de Buenos Aires, Facultad de Medicina, 2006.
8. Chapman PG, Villar RN. The bacteriology of bone allografts. J Bone Joint Surg 1992;74(3):398-9.
https://doi.org/10.1302/0301-620X.74B3.1587886
9. Escribano Rey RJ, Vázquez García BL. Contamination of tissue allografts from a deceased donor through haematic dissemination: a case study. Cell Tissue Bank 2010;11(3):295-8. https://doi.org/10.1007/s10561-009-9153-0
10. Veen MR, Bloem RM, Petit PLC. Sensitivity and negative predictive value of swap cultures in musculoskeletal
allograft procurement. Clin Orthop Relat Res 1994;300:259-63. PMID: 8131346
11. Barrios RH Leyes M, Amillo S, Oteiza C. Bacterial contamination of allografts. Acta Orthop Belg 1994;60(2):152-
4. PMID: 8053313
12. James LA, Ibrahim T, Esler CN. Microbiological culture results for the femoral head. Are they important to the
donor? J Bone Joint Surg Br 2004;86(6):797-800. https://doi.org/10.1302/0301-620x.86b6.14783
13. Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 1995;77(11):1742-4. https://doi.org/10.2106/00004623-199511000-00017
14. Schratt HE, Regel G, Kiesewetter B, Tscherne H. [HIV infection caused by cold preserved bone transplants].
Unfallchirurg 1996;99(9):679-84. [En alemán] https://doi.org/10.1007/s001130050042
15. Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL. What are the risk factors and management options for
infection after reconstruction with massive bone allografts? Clin Orthop Relat Res 2016;474(3):669-73.
https://doi.org/10.1007/s11999-015-4353-3
16. Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive bone allografts. Clin Orthop Relat Res 2005;(432):210-6. https://doi.org/10.1097/01.blo.0000150371.77314.52
17. Dion N, Sim FH. The use of allografts in orthopaedic surgery. Part I: the use of allografts in musculoskeletal
oncology. J Bone Joint Surg Am 2002;84:644-54. Disponible en:
https://www.proquest.com/openview/f0b36838f75fd8144404891634c121d7/1?pq-origsite=gscholar&cbl=289
18. Enneking WF, Mindel ER. Observations on massive retrieved human allografts. J Bone Joint Surg Am 1991;73(8): 123-34. PMID: 1890115
19. Frisoni T, Cevolani L, Giorgini A, Dozza B, Donati DM. Factors affecting outcome of massive intercalary bone
allografts in the treatment of tumours of the femur. J Bone Joint Surg Br 2012;94(6):836-41. https://doi.org/10.1302/0301-620X.94B6.28680
20. Delloye C, van Cauter M, Dufrane D, Francq BG, Docquier PL, Cornu O. Local complications of massive bone
allografts: an appraisal of their prevalence in 128 patients. Acta Orthop Belg 2014;80(2):196-204. PMID: 25090792
21. Aponte-Tinao L, Farfalli G, Ritacco L, Ayersa M, Muscolo L. Intercalary femur allografts are an acceptable
alternative after tumor resection. Clin Orthop Rel Res 2012;470(3):728-34. https://doi.org/10.1007/s11999-011-1952-5
22. Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am
2001;83(7):971-86. PMID: 11451965
23. Hazan EJ, Hornicek FJ, Tomford WW. The effect of adjuvant chemotherapy on osteoarticular allografts. Clin Orthop 2001;(385):176-81. https://doi.org/10.1097/00003086-200104000-00027
24. Davy DT. Biomechanical issues in bone transplantation. Clin Orthop North Am 1999;30(4):553-63.
https://doi.org/10.1016/s0030-5898(05)70108-5
2. Zamborsky R, Svec A, Bohac M, Kilian M, Kokavec M. Infection in bone allograft transplants. Exp Clin Transplant
2016;14(5):484-90. PMID: 27733106
3. Rogers BA, Sternheim A, De Iorio M, Backstein D, Safir O, Gross AE. Proximal femoral allograft in revision hip
surgery with severe femoral bone loss: a systematic review and metaanalysis. J Arthroplasty 2012;27(6): 829-36.
https://doi.org/10.1016/j.arth.2011.10.014
4. Aponte-Tinao LA, Ritacco LE, Albergo JI, Ayerza MA, Muscolo DL, Farfalli GL. The principles and applications
of fresh frozen allografts to bone and joint reconstruction. Orthop Clin North Am 2014;45(2):257-69.
https://doi.org/10.1016/j.ocl.2013.12.008
5. Lemos Azi M, Aprato A, Santi I, Kfuri M Jr, Masse A, Joeris A. Autologous bone graft in the treatment of posttraumatic bone defects: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016;17(1):465.
https://doi.org/10.1186/s12891-016-1312-4
6. Mikhael MM, Huddleston PM, Nassr A. Postoperative culture positive surgical site infections after the use of
irradiated allograft, nonirradiated allograft, or autograft for spinal fusion. Spine 2009;34(22):2466-8.
https://doi.org/10.1097/BRS.0b013e3181b1fef5
7. Varaona JM. Banco de Tejido Óseo: Pautas para un funcionamiento eficiente y seguro. Tesis de Doctorado en
Medicina. Universidad de Buenos Aires, Facultad de Medicina, 2006.
8. Chapman PG, Villar RN. The bacteriology of bone allografts. J Bone Joint Surg 1992;74(3):398-9.
https://doi.org/10.1302/0301-620X.74B3.1587886
9. Escribano Rey RJ, Vázquez García BL. Contamination of tissue allografts from a deceased donor through haematic dissemination: a case study. Cell Tissue Bank 2010;11(3):295-8. https://doi.org/10.1007/s10561-009-9153-0
10. Veen MR, Bloem RM, Petit PLC. Sensitivity and negative predictive value of swap cultures in musculoskeletal
allograft procurement. Clin Orthop Relat Res 1994;300:259-63. PMID: 8131346
11. Barrios RH Leyes M, Amillo S, Oteiza C. Bacterial contamination of allografts. Acta Orthop Belg 1994;60(2):152-
4. PMID: 8053313
12. James LA, Ibrahim T, Esler CN. Microbiological culture results for the femoral head. Are they important to the
donor? J Bone Joint Surg Br 2004;86(6):797-800. https://doi.org/10.1302/0301-620x.86b6.14783
13. Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 1995;77(11):1742-4. https://doi.org/10.2106/00004623-199511000-00017
14. Schratt HE, Regel G, Kiesewetter B, Tscherne H. [HIV infection caused by cold preserved bone transplants].
Unfallchirurg 1996;99(9):679-84. [En alemán] https://doi.org/10.1007/s001130050042
15. Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL. What are the risk factors and management options for
infection after reconstruction with massive bone allografts? Clin Orthop Relat Res 2016;474(3):669-73.
https://doi.org/10.1007/s11999-015-4353-3
16. Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive bone allografts. Clin Orthop Relat Res 2005;(432):210-6. https://doi.org/10.1097/01.blo.0000150371.77314.52
17. Dion N, Sim FH. The use of allografts in orthopaedic surgery. Part I: the use of allografts in musculoskeletal
oncology. J Bone Joint Surg Am 2002;84:644-54. Disponible en:
https://www.proquest.com/openview/f0b36838f75fd8144404891634c121d7/1?pq-origsite=gscholar&cbl=289
18. Enneking WF, Mindel ER. Observations on massive retrieved human allografts. J Bone Joint Surg Am 1991;73(8): 123-34. PMID: 1890115
19. Frisoni T, Cevolani L, Giorgini A, Dozza B, Donati DM. Factors affecting outcome of massive intercalary bone
allografts in the treatment of tumours of the femur. J Bone Joint Surg Br 2012;94(6):836-41. https://doi.org/10.1302/0301-620X.94B6.28680
20. Delloye C, van Cauter M, Dufrane D, Francq BG, Docquier PL, Cornu O. Local complications of massive bone
allografts: an appraisal of their prevalence in 128 patients. Acta Orthop Belg 2014;80(2):196-204. PMID: 25090792
21. Aponte-Tinao L, Farfalli G, Ritacco L, Ayersa M, Muscolo L. Intercalary femur allografts are an acceptable
alternative after tumor resection. Clin Orthop Rel Res 2012;470(3):728-34. https://doi.org/10.1007/s11999-011-1952-5
22. Enneking WF, Campanacci DA. Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am
2001;83(7):971-86. PMID: 11451965
23. Hazan EJ, Hornicek FJ, Tomford WW. The effect of adjuvant chemotherapy on osteoarticular allografts. Clin Orthop 2001;(385):176-81. https://doi.org/10.1097/00003086-200104000-00027
24. Davy DT. Biomechanical issues in bone transplantation. Clin Orthop North Am 1999;30(4):553-63.
https://doi.org/10.1016/s0030-5898(05)70108-5