Frozen musculoskeletal allografts. A study of the clinical incidence and causes of infection associated with their use.

Tomford, W W; Thongphasuk, J; Mankin, Henry J.; Ferraro, M J

doi:10.2106/00004623-199072080-00003

Cited by 229 publications

(136 citation statements)

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“…The infection frequency in this series was 9% (60 infections in 673 patients) and is similar to previous reports [2,4,6,7,10,12,13]. Lord et al [6] reported a 11.7% infection rate (33 infections in 283 patients); their series did not differ with regard to age, sex, type of allograft, or site of the allograft.…”

Section: Discussionsupporting

confidence: 89%

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What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Aponte-Tinao

Ayerza

Múscolo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important. Questions/purposes The purposes of this study were (1) to analyze the frequency of infection in a group of patients treated with massive bone allografts; (2) to analyze risk factors such as age, sex, affected bone, type of reconstruction, operative room used, primary or revision procedure, length of postoperative antibiotic administration, and use of chemotherapy; and (3) to determine the likelihood that treatment of an infected allograft will result in a successful reconstruction.Methods We retrospectively analyzed the records of patients treated with massive bone allografts for a benign or malignant bone tumor or as a revision for a previous limb salvage procedure between 1985 and 2011. During this period, 673 patients were reconstructed with massive bone allografts in long bones, which included 272 osteoarticular, 246 intercalary, and 155 allograft-prosthetic composite reconstructions. Using a chart review, we ascertained the frequency of infection and reoperations after the treatment of infected allografts. Minimum followup was 2 years unless death occurred earlier (mean, 106 months; range, 6-360 months), and no patient was lost to followup. The selected variables were analyzed using multivariate logistic regression to identify risk factors for infection. We analyzed survivorship free of infection as the endpoint. Results During followup, 60 patients (9%) had a bacterial infection of the allograft with a survivorship free from infection of 92% at 5 years (95% confidence interval [CI], 90%-94%) and 91% at 10 years (95% CI, 89%-93%). We found that tibia allografts (p\0.001; odds ratio [OR], 3.17; 95% CI, 1.80-5.60), male patients (p \ 0.029; OR, 1.92; 95% CI, 1.08-3.49), procedures performed in a conventional operating room (p \ 0.002; OR, 3.15; 95% CI, 1.58-6.62), and the use of longer periods of postoperative antibiotics (p \ 0.041; OR, 2.25; 95% CI, 1.02-4.88) were patient factors associated with a greater risk of infection. In 11 patients (18%, 11 of 60 infections) the infection was controlled with antibiotics and surgical débridement; however, in 49 patients (82%, 49 of 60 infections), this approach failed, so the allograft was removed and a temporary cement spacer with antibiotic was implanted to control the infection. Forty-one patients subsequently had the spacer removed and were reconstructed after infection control with another bone allograft in 24 and an endoprostheses in 17. Four patients underwent an amputation

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Section: Discussionsupporting

confidence: 89%

“…Although many papers that analyzed allograft reconstructions described the frequency of infection [1,3,8,9,13], only a few papers analyzed the management of this complication [2,6,7]. Those reports that have analyzed the frequency and treatment of bone allograft infections [2,6,7] did not provide the likelihood of reinfection.…”

Section: Introductionmentioning

confidence: 99%

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Aponte-Tinao

Ayerza

Múscolo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Although autografts are still the gold standard, bone allografts are being used progressively and are increasingly necessary for spinal arthrodesis [8,10,19,21]. The use of autograft bone is not without complications or problems because of harvesting and donor site morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of allografts are their unlimited quantity, the time saving during surgery and the avoidance of donor site morbidity [8]. Several studies have shown that the risks are acceptable and results similar to those obtained with autografts [8,10,14,15,19,21]. Bioactive ceramics may also be considered a good alternative when doing a posterior fusion, with no risk of transmitting disease.…”

Section: Discussionmentioning

confidence: 99%

“…There is always a potential risk of disease or infection transmission from the donor to the recipient with the use of allografts [8,10,19,20], though since 1988 only eight cases of bone-transplantation-associated HIV infection have been reported and bacterial allograft infection is almost negligible (4-5%) [2,12,19,21]. However, we could find no previous cases reports on positive cultures detected after graft implantation even though all the bank cultures were initially negative.…”

Section: Introductionmentioning

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Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine

Barriga

Díaz-de-Rada

Barroso

et al. 2004

European Spine Journal

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Kinetics of cortical bone demineralization: Controlled demineralization?a new method for modifying cortical bone allografts

Lewandrowski¹,

Venugopalan²,

Tomford³

et al. 1996

J. Biomed. Mater. Res.

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We investigated the kinetics of hydrochloric acid demineralization of human cortical bone with the objective of developing a method of controlled demineralization for structural bone allografts. It is known that the demineralization of cortical bone is a diffusion rate limited process with a sharp advancing reaction front. The demineralization kinetics of human cortical bone, described as the advance of the reaction front versus immersion time, were determined by measuring extraction of bone mineral in both planar and cylindrical geometries. Mathematical models based on diffusional mass transfer were developed to predict this process. The experimental data fit well with the behavior predicted by the model. The model for planar geometry is applicable to controlled demineralization of cortical bone allografts of irregular shapes such as cortical struts. The model for cylindrical geometry is appropriate when curved surfaces are involved such as in diaphyseal bone allografts. This method of demineralization has direct application to clinical modification of cortical bone allografts to potentially enhance their osteoinductive properties.

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Frozen musculoskeletal allografts. A study of the clinical incidence and causes of infection associated with their use.

Cited by 229 publications

References 0 publications

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine

Kinetics of cortical bone demineralization: Controlled demineralization?a new method for modifying cortical bone allografts

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