Background

Bone allografts have been used for surgical treatment of large bone defects, especially in endoprothesis replacement and spinal surgery. From patients undergoing primary total hip arthroplasty (THA), their femoral heads and necks were collected in the operation theatre. They were stored fresh frozen unchanged or converted into bone chips aseptically by the Bone Bank. In order to meet the demand for bone allografts we analysed the entire procedure for potential of improvement.

Methods

We analysed key data from the bone bank´s registry and the hospital administration between January 2019 and December 2022 with regard to the harvest of fresh frozen allogenic femoral heads and necks, the manufacture of bone chips and their discard rates and reasons over time: donor history, microbial growth, histology, IDM testing, others. Criteria for donor eligibility and product release were assessed in accordance with EU and national legislation.

Results

890 femoral heads and necks were harvested during 1,664 THA surgeries. Thanks to the relaxation of Covid-19 restrictions, equal amounts of bone donations were recovered in 2022 and in 2019, 41% of these yielded the bulk material for bone chips. The discard rate for bone chips remained below 1.5%, but increased from 14.7% to 16% for bone donations. Analysis of the reasons for discard revealed donor history as the major cause over time. The increase from 5.6% in 2021 to 8.4% in 2022 had occured despite some improvement measures e.g. clarification of inconclusive diagnoses and a revised donor questionnaire. Thus, other factors may also contribute, such as the inclusion of increasingly older bone donors and staff turnover.

Conclusion

Providing allogeneic bone grafts of high quality and in sufficient quantity is a challenge. Therefore, it is of utmost importance to regularly review the registry data in order to adjust the procedures if necessary and possible. In this complex task other factors, such as donor characteristics and structural changes should also be considered.

Offenlegung Interessenkonflikt:

No conflicts of interest to declare