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What is a bone graft?

Surgeons use bone grafts to repair and rebuild bones in hips, knees, spine and sometimes other bones and joints.

If the transplanted bone comes from another person, it is called an allograft. Most allograft bone comes from donors who have died. Tissue banks then disinfect and test the donated bone to make sure it is safe prior to use.

If the transplanted bone comes from another part of the patient’s own body, it is called an autograft. Autograft bone often comes from your ribs, pelvis, hips or a leg.

Why is bone grafting performed?

Bone grafting is done to treat both injury, infection and disease.

There are four main reasons bone grafts are used:

    • Fractures - a bone graft may be used in the case of multiple or complex fractures or those that do not heal well after an initial treatment
    • Fusion - most often done in the foot and spine, fusion helps two bones heal together across a diseased joint
    • Regeneration - for bone lost to disease, infection, or injury, this can involve using small amounts in bone cavities or large sections of bones
    • Implanted devices - a graft can be used to help bone heal around surgically implanted devices, like joint replacements, plates, or screws

Disadvantages of autograft and allograft

Autologous bone grafting is still considered the ‘gold standard’, because using your own tissue creates the best conditions for the graft to heal, as there is less chance of rejection.

However, there are a number of well-known complications associated with this technique, including chronic pain, which can often overshadow that of the primary operation, temporary or permanent loss of sensation or infection at the donor site, requiring either further treatment or medication.

Allografts offer an attractive alternative to autograft, because they are more readily available.

However, the biggest drawback of allograft is that it has a high incidence of failure, with up to 50% of patients needing a second operation, and they carry the risk of transmission of disease because allograft contains living cells.

In an attempt to overcome the disadvantages of autograft and allografts, 'artificial’ or synthetic bone graft substitutes such as CERAMENT® have been developed.

Synthetic bone graft substitutes - CERAMENT®

CERAMENT is a synthetic bone graft substitute developed by BONESUPPORT™ that is a combination of calcium sulphate and the calcium phosphate hydroxyapatite.

It is the result of years of research by the company's founder Prof. Lars Lidgren, who set out to develop a synthetic bone substitute with an 'ideal' set of characteristics, which he felt no other synthetic bone substitute on the market fulfilled.

It remodels into the patients own bone - by being resorbable and osteoconductive, it provides a scaffold to support the growth of new bone cells. Bone remodeling ensures that any bone defect is filled, and reduces the risk of recurrence of infection and fracture

Completely fills the hole in the bone – by being injectable and flowable it ensures that no small spaces are left which could encourage bacterial growth

Biocompatible and non-toxic

Isothermic – it does  not produce heat, which could damage tissues

Easy to use – a material that is pre-packed, easily available and can be stored and mixed at room temperature in a simple process

 

CERAMENT can be used to fill bony voids and defects as a result of trauma, infection, disease or related surgery.

REFERENCES

www.nlm.nih.gov/medlineplus/bonegrafts.html

http://en.wikipedia.org/wiki/Bone_grafting

www.aaos.org/news/aaosnow/jan08/reimbursement2.asp

Banwart, JC et al. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976). 1995 May 1; 20(9):1055-60

Dimitriou, R et al. Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 2011; 42(Supplement 2): S3-S15

Zheng MH et al. Mechanism of bone allograft failure. J Bone Joint Surg Br 2002 vol. 84-B no. SUPP III 234

Delloye C et al. Bone allografts – What they can offer and what they cannot. J Bone Joint Surg Br May 2007 vol. 89-B no. 5 574-580

Edward MY & Michael WC. MORBIDITY AT BONE GRAFT DONOR SITES. Reprinted from JOURNAL OF ORTHOPAEDIC TRAUMA, 1989 Vol. 3, No. 3, pp. 192-195

Eastlund, T. Infectious disease transmission through tissue transplantation: reducing the risk through donor selection. J Transpl Coordination 1991;1:23-30

Delloye, C. Tissue allografts and health risks. Acta Orthop Belg 1994; 60(Suppl 1):62-7

Tomford, W. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg [Am] 1995;77-A:1742-54

Pereira, B et al. Transmission of hepatitis C virus by organ transplantation. New Engl J Med 1991;325:454-60

Roth, D et al. Detection of hepatitis C virus infection among cadaver organ donors: evidence for low transmission of disease. Ann Intern Med 1992;117:470-5

Conrad, E et al. Transmission of the hepatitis-C virus by tissue transplantation. J Bone Joint Surg [Am] 1995;77-A:214-24.

Carlson, E et al. The potential for HIV transmission through allogeneic bone: a review of risks and safety. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80:17-23 

Nyberg, M  et al. Isolation of human immunodeficiency virus (HIV) at autopsy one to six days post-mortem. Am J Clin Pathol 1990;94:422-5