Abstract
For the technical aspects of this subject the Marseilles team collaborated with the Etablissement de Transfusion Sanguine Alpes-Provence (Alpes-Provence Blood Transfusion Service) to set up a bone bank on their premises because it has a competent cryobiology department equipped with storage tanks containing liquid nitrogen and a temperature-lowering programmer. This laboratory, which for a long time has been storing bone marrow, platelets, and various cryopreserved tissues, has the virology, bacteriology, quality control, and quality assurance laboratories of the Blood Transfusion Service and is accustomed to applying the transfusion safety standards. It was also one of the first in France to obtain the approval of the Microbiological Safety Committee of the Directorate General of Health in April 1996. Banks which were developed nationally have followed the same principles and currently more a hundred have been registered and some are awaiting authorization.
Access provided by Autonomous University of Puebla. Download chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
For the technical aspects of this subject the Marseilles team collaborated with the Etablissement de Transfusion Sanguine Alpes-Provence (Alpes-Provence Blood Transfusion Service) to set up a bone bank on their premises because it has a competent cryobiology department equipped with storage tanks containing liquid nitrogen and a temperature-lowering programmer. This laboratory, which for a long time has been storing bone marrow, platelets, and various cryopreserved tissues, has the virology, bacteriology, quality control, and quality assurance laboratories of the Blood Transfusion Service and is accustomed to applying the transfusion safety standards. It was also one of the first in France to obtain the approval of the Microbiological Safety Committee of the Directorate General of Health in April 1996. Banks which were developed nationally have followed the same principles and currently more a hundred have been registered and some are awaiting authorization.
The Removal of Articular and Osteocartilaginous Grafts
Because the bone and cartilage fragments which are removed are not subjected to secondary sterilization, it is imperative that therapeutic maneuvers are performed in wholly sterile conditions.
Selection of the Donors
Selection has to be rigorous so that there is no risk of the transmission of iatrogenic pathology to the host through the graft. This requires adequate knowledge of the history of the illness and the circumstances of the accident, as well as the medical history of the donor. There are many absolute contra-indications. Subjects with a cancerous condition, a systemic illness, collagenosis, an auto-immune disease, or bone dystrophy may not have tissue removed for grafts. We systematically eliminate from the list of donors those suffering from a viral, bacteriological, or parasitic infection, mycosis or tuberculosis as well as those with risk factors and those who have been on artificial ventilation for more than 72 h in intensive care, as they are potentially infected. As far as the validation of the grafting material is concerned, the banks have to conform to the legislation in force decreed by the French Graft Institute.
Bacterial decontamination is performed using a solution of antibiotics consisting of rifocine and chloramphenicol.
Samples are taken from each graft before and after decontamination and after thawing. Positive bacteriological results will mean that the tissues will have to be destroyed.
Blood samples have to be taken from each donor (live or deceased) in order to perform the obligatory virological examinations.
In accordance with the decrees of 25 February, 1992, of 24 May, 1994, and of 24, July 1996, medical biological analyses are performed to test for infection:
-
by the hepatitis B virus (HBs antigen and anti-HBc antibodies),
-
by HIV (antigen P24 and anti-HIV 1 and 2 antibodies),
-
by HTLV (anti-HTLV 1 and 2 antibodies),
-
by hepatitis C (anti-HCV antibodies),
-
for detecting syphilis in two different tests (VDRL and TPHA),
-
for assaying for transaminases for the live donors.
Decree No. 97–928 of 9 October, 1997 removes the obligation to carry out a search for the agent responsible for toxoplasmosis, for infection by cytomegalovirus, and by the Epstein-Barr virus. The Decree of 1 April, 1997 requires that the results of the examinations performed are examined before the patients have been transfused, as any hemodilution could falsify the tests. Finally, the French Blood Agency and the French Graft Institute recommend that the tissues are placed into quarantine and that the virological tests are repeated 4–6 months after the tissue has been removed. These samplings are performed either on the live donor or on the host of organs coming from the same donor and are performed to reduce the risk in the event of the tissue having been removed during a seroconversion phase. However, placing these products into quarantine is only one of the possible ways of ensuring safety. A decree will specify the conditions under which it is to be performed in the various situations according to the other methods which could be used, in particular directly testing for the viruses by molecular biology techniques (PCR).
Removal Techniques
As the risk of infection is the main concern in this surgery, the various stages of surgery must be performed under the strictest aseptic conditions possible. The tissue therefore has to be removed in an operating theatre, according to the same principles as regulated orthopedic surgery, and it is considered that a maximum time lapse of 6 h from the circulation stopping can be reasonably accepted. For joint removals, the whole of the joint capsule is preserved as well as the intra-articular ligaments and the menisces or labra. In the case of the knee, and in order to keep the extensor apparatus intact, we retain the whole of the patellar tendon continuously with the posterior half of the patellar joint. This is also continuous with the quadricipital tendon, the upper part of which is cut into an inverted V. The muscular insertions are scraped and the surgeon removing the tissue cleans all the bone attachments of the ligaments allowing the capsule to be refixed firmly. The part is then placed in a bag which is resistant to very low temperatures (captonteflon bags). The reconstruction of the skeleton is one of the important stages of the removal. It is a legal obligation and it has to be as perfect as possible.
Coding and Measuring of the Parts
In order to find the desired bone fragment again easily in the bank, it is necessary to fill in the data sheet carefully and to perform X-rays without enlargement or with an enlargement control placed side-by-side with the bone part.
Quality Controls
All the bone banks have to be inspected periodically, and samplings are performed on a very regular basis (20 % of the grafts are rejected annually, either immediately after having been removed on account of positive results being found in tests or subsequently at the 6-month checks).
Preservation Techniques
Preservation Methods
Many preservation methods have been suggested since the use of allografts was first considered. The techniques of irradiation and sterilization by moist heat will be described in detail subsequently. Cryopreservation is the only current procedure which makes it possible to preserve bone fragments and in particular cartilage cells safely.
Preserving fluids (antiseptics, 1 % sodium methyolate, β propriolactoses), as well as ethylene oxide are cytotoxic and the problems involved in handling them have meant that they have been abandoned. The same applies for the methods involving sterilization by boiling.
Drying under vacuum or lyophilization uses plasma preservation processes. These grafts, which are theoretically usable indefinitely at ordinary temperatures, are fragile and are not sufficiently strong in mechanical terms to withstand the usual mechanical stresses and, in particular, all the cells are destroyed preventing the use of friction surfaces.
Irradiation of bone fragments taken under conditions which are not sterile is recommended by some teams who see a practical advantage for taking grafts. However, not only does this irradiation, conventionally performed at 25 K Gray, not guarantee perfect viral sterility but it also causes the destruction of all the cells.
Since 1981 we have been using cryopreservation of massive osteocartilaginous grafts in liquid nitrogen at −196 °C. This method makes it possible to preserve whole bones and complete joints over an extended period as it preserves the viability of the cartilaginous cells, the fibers, and fibroblasts contained in the ligaments and capsules.
Without going into the technical details of cryopreservation and storage, we would like to underline the fact that tissue preservation has to obey two essential rules:
-
uppression of cadaveric disintegration phenomena,
-
preservation for an extended period of the architecture of the bone and preservation of the viability of the cartilaginous cells.
To avoid the formation of ice macrocrystals, it is necessary to impregnate the bone, cartilage, and ligament tissues with a suitable cryoprotector. At Marseilles, we use a mixture of macro-molecules (4 % human albumin which is to be replaced by Héloes) and 10 % final DMSO. This solution is maintained at a temperature of 4 °C because DMSO is toxic. In theory, the “deep cold” should enable these objectives to be reached by stopping the action of the tissue enzymes. If relatively moderate freezing temperatures are used (higher than −20 °C), the enzymes present in the tissue are not inactivated and will destroy the architecture of the graft in a few weeks. At −80 °C (limit of electric freezers), although the enzymatic activity is clearly reduced, it is not totally stopped, only collagenase is inactivated at this temperature. At −196 °C all the enzymes are inactivated and the proteins can be preserved over an extended period. On the other hand, DMSO has a eutectic point around −60 °C, at this temperature, the microcrystals of ice can recombine into macro-crystals and make the cells burst. For the same reasons, the temperature of the graft cannot be lowered in an haphazard fashion, and it is necessary to vary the rate at which this takes place in accordance with the temperature obtained. The optimum curve seems to us to be 2 °C per minute down to −40 °C then 5 °C per minute down to −140 °C, the temperature at which the graft is then placed in nitrogen vapor, directly in the tank where it is stored.
Thawing, on the other hand, has to be rapid so that the largest number of cells remain alive. Physiological serum or Ringer’s lactate solution at 40–41 °C will be used to thaw out and wash the grafts in order to eliminate the DMSO. Approximately 2 h after having removed the bone fragments from the liquid nitrogen tank, they are usable for a period of approximately 24–26 h, which means that they can be taken to any part of France and Europe. However, donors are becoming rarer and rarer and it is becoming increasingly difficult to obtain tissue.
Biomechanics and Immunology
The mechanical strength of the cortical allograft is only 50–60 % of the strength of normal bone during a period ranging from the 8th to the 18th month after the graft has been implanted (on account of the revascularization of the bone). Maximum fragility is at around the 12th month and it is only after 2–3 years after the graft has been implanted that the bone regains normal density and biomechanical strength. The fixation of the graft therefore has to be complete in order for this period of fragility to come to an end. The mechanical properties of the allografts can be changed by the preservation and storage processes. Lyophilization, massive irradiation of the grafts (in excess of three megarads), or moist heat used for more than 60 min at 120 °C adversely affect the mechanical behavior of the grafts considerably. Cryopreservation, on the other hand, seems to improve the mechanical properties of the allograft, the strength of which is 110–120 % that of fresh bone but the graft, although it is stronger, does in fact become more brittle (in the mechanical sense of the term) and therefore breakable. In the case of articular allografts, the crucial point is preservation of the ligament structures, of the synovial fluid, and of the menisces. The cells in these formations are preserved, as are their architectural and fundamental structure.
After having been reinstated, the vascularization is linked to the revascularization of the bone insertion area. It is inadequate for several months (or years) which means that they have to be doubled with an artificial ligament during this period to avoid excess stresses which would lead to their being stretched or even ruptured. The extent of the immunologically competent tissue (synovial, capsule, etc.) also risks leading to the occurrence of immunological rejection phenomena justifying the use of immunosuppressants (such as Sandimmum) in the event of the hyperproduction of fluid indicating an immune response.
Transport
Transporting bone parts over long distances will require the use of special containers, in which grafts will be preserved at low temperatures (liquid nitrogen or dry ice). When it is anticipated that these grafts will be used within 24 h following removal from the Bank, it is preferable to thaw the bone fragment and to dispatch it only after thawing. Once removed from liquid nitrogen, the graft has to be used within 24 h and it is not possible to refreeze it again if it is not used.
Use
The best indications for using these osteocartilaginous or complete joint grafts are in the knee, ankle, shoulder, elbow, and wrist.
Isolated Osteocartilaginous Grafts
-
Partial or total graft of the femoral condyle,
-
graft of the tibial plateau,
-
graft of the patella,
-
graft of the tibial pylon,
-
partial graft of the humeral head,
-
partial graft of the elbow,
-
graft of the inferior radius.
The graft is fixed by osteosynthesis material and the ligaments of the host are refixed onto the graft. The functional results are generally excellent.
Osteocartilaginous Graft Plus Ligaments from the Donor
The excision is larger and the donor ligaments remain attached to the graft and are refixed onto the host bone or over the ligaments of the host. They have to be protected during the period of revascularization by artificial ligaments.
This applies to:
-
massive grafts of the inferior extremity of the femur,
-
massive grafts of the superior or inferior extremity of the tibia,
-
grafts of the humeral head,
-
partial grafts of the elbow.
Complete Articular Grafts
A total joint graft with its capsule, its synovial membrane, its ligaments, and the fibrocartilages it contains (meniscus or labrum) is indicated in the case of an extensive tumoral lesion in the joint cavity justifying extensive excision in a single piece.
The problems posed are twofold:
-
Immunological: connected with the size of the immunologically competent material implanted with apparently an inflammatory reaction which could result in a cutaneous fistula giving rise to an infection.
-
Mechanical: the ligaments must not be strained during the period of their revascularization and have to be doubled up by artificial ligaments.
Reconstruction Prostheses Sheathed with Bone from a Bone Bank
The indications for using a prosthesis sheathed with bone from a bone bank are often present and have to be analyzed according to the extent of the loss of musculo-ligament and cutaneous substance which requires tumoral excision or which has been produced by the trauma.
Conclusion
It seems to us to be important to emphasize the fact that grafts have to be preserved without breaking the cold chain, without damaging the bags containing the graft, and under strictly technological conditions. The importance of the sterile environment for removing the graft has to be emphasized; for example, out of more than 5,000 parts preserved in the Blood Transfusion Center in Marseilles since 1981, we have had to destroy barely 2 % due to a super-infection being found. These encouraging results are due to extreme rigor in the ways in which the grafts are removed and the patients are selected. In our opinion, these preservation methods are the only ones which allow the bone, and particularly the cartilage, to still be guaranteed a normal structure and also good mechanical properties.
Bibliography
Babin SR, Katzner M, Vidal PH, Simon P, Kempf JF, Keiling R, Schvingt E. Résection – reconstruction diaphysaire fémorale par allogreffe massive fixée par clou médullaire vérouillé. Rev Chir Orthop Reparatrice Appar Mot. 1987;73:25–9.
Beaver RJ, Mahomed M, Bachstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for post-traumatic defect in the knee. J Bone Joint Surg Br. 1992;74-B:105–10.
Brooks DB, Heiple KC, Herdon CH, Powell AE. Immunological factors in homogenous bone transplantation. IV The effect of various methods of preparation and irradiation on antigenicity. J Bone Joint Surg. 1969;45A:1617.
Brown K, Crues SR. Bone and cartilage transplantation, in orthopeadic surgery. J Bone Joint Surg Am. 1982;64:270–9.
Burchardt H. The biology of bone graft repair. Clin Orthop. 1983;174:121–35.
Burchardt H, Enneking WF. Transplantation of bone. Surg Clin North Am. 1978;58:409.
Burchardt H, Jones H, Gloweczewskie F, Rudner C, Enneking WF. Freeze-dried allogeneic segmental cortical bone grafts in dogs. J Bone Joint Surg. 1978;60A:1082.
Burwell RG. Studies in the transplantation of bone. V. The capacity of fresh and treated homografts of bone to evoke transplantation immunity. J Bone Joint Surg. 1963;45B:386.
Burwell RG. The fate of bone grafts. In: Apley AG, editor. Recent advances in orthopeadic. Baltimore: The Williams & Wilkins Co; 1969. p. 115.
Burwell RG. The fate of freeze-dried bone allografts. Transplant Proc. 1976;8 Suppl 1:95.
Burwell RG, Gowland G. Studies in the transplantation of bone. III. The immune responses of lymphnodes draining components of fresh homologous cancellous bone and homologous bone treated by different methods. J Bone Joint Surg. 1962;44B:131.
Burwell RG, Gowland G, Dexter F. Studies in the transplantation of bone. VI Further observations concerning the antigenicity of homologous cortical and cancellous bone. J Bone Joint Surg. 1963;41B:597.
Carr CR, Hyatt GW. Clinical evaluation of freeze-dried bone grafts. J Bone Joint Surg. 1955;37A:549.
Carrel A. La conservation des tissus et ses applications en chirurgie. J Am Med – Techniques chirurgicales orthopédique, Paris. 1984;44090:4–7–10.
Chalmers J. Transplantation immunity in bone grafting. J Bone Joint Surg. 1959;41B:160.
Charpentier B. Mécanisme du rejet des allogreffes. Presse Med. 1984;13:2697–700.
Chrisman OD, Fessel JM, Southwick WO. Experimental production of synovitis and marginal articular exostose in the knee joint of dogs. Yale J Biol Med. 1964;37:409.
Coutelier L, Delloye CH, De Nayer P, Vincent A. Aspects microradiographiques des allogreffes osseuses chez l’homme. Rev Chir Orthopédique. 1984;70:581–8.
Cracchiolo III A, Michaeli D, Goldberg LS, Fudenberg HH. The occurrence of antibodies to collagen in synovial fluids. Clin Immunol Immunopathol. 1975;3:567.
Curran WJ. The uniform anatomical gift act. N Engl J Med. 1969;280:36.
Darcy DA. Reaction of rabbits to frozen homografts. Pathol Bacteriol. 1955;70:143.
Devries PH, Badgley CE, Hartman JT. Radiation sterilization of homogenous-bone transplants utilizing radioactiv cobalt. Preliminary report. J Bone Joint Surg Am. 1958;40:187–203.
Duffy P, Wolf J, Collins G, De Voe AG, Streeten B, Cowen D. Possible person-to-person transmission of Creutzfeld-Jacob disease. N Engl J Med. 1974;290:692.
Duparc J, Nordin JY, Olivier H, Augereau B. Les résections-reconstructions dans les tumeurs osseuses des membres et du bassin. Encycl Méd Chir – Techniques Chirurgicales Orthopédie. 1984;44090:4–7–10.
Elves MW. Humoralimmune response to allografts of bone. Int Arch Allergy Appl Immunol. 1974;47:708.
Elves MW. Newer knowledge of immunology of bone and cartilage. Clin Orthop. 1976;120:232.
Elves MW, Ford CHJ. A study of the humoral immunce response to osteoarticular allografts in the sheep. Clin Exp Immunol. 1974;17:497.
Friedlaender GE. Current concepts. Review: bone-banking. J Bone Joint Surg Am. 1982;64:307–11.
Friedlaender GE. Immune response to osteochondral allografts. Clin Orthop. 1983;174:58–67.
Friedlaender GE, Ladenbauer-Bellis I, Chrisman OD. Cartilage matrix components as antigenic agents in a osteoarthritis model. Trans Orthop Res Soc. 1980;5:170.
Friedlaender GE, Mankin HJ. Guidelines for the banking of musculoskeletal tissues. Am Assoc Tissues Banks Newsletter. 1980;4(suppl):30.
Friedlaender GE, Mankin HJ, Kenneth W. Osteochondral allografts (biology, banking and clinical applications). Boston Toronto: Little Brown; 1982.
Friedlaender GE, Strong DM, SELL KW. Studies on the antigenicity of bone. I. Freeze-dried and deep-frozen bone allografts in rabbits. J Bone Joint Surg. 1976;58A:854.
Friedlaender GE, Strong DM, Sell KW. Donor graft specific anti-HL-A antibodies following freeze-dried bone allografts. Trans Orthop Res Soc. 1977;2:87.
George CR, Chrisman OD. The role of cartilage polysaccharides in osteoarthritis. Clin Orthop. 1968;57:259.
Glant T, Hadas E, Nagry TJ. Cell-mediated and humoral immune responses to cartilage antigenic components. Scand J Immunol. 1979;9:29.
Golberg V, Heiple K. Experimental hemijoint and whole transplantation. Clin Orthop. 1983;174:43–53.
Goldberg V, Bos G, Heiple K, Zita J, Powell A. Improved acceptance of frozen bone allografts in genetically mismatched dogs by immunosuppression. J Bone Joint Surg Am. 1984;66:937–50.
Greiff D, Milson TJ. Functional activities of isolated lymphocytes following drying by sublimation of ice in vacus. I. Rosette formation, stimulation by plant lectins (mitogens) and the mixed lymphocyte reaction. Cryobiology. 1980;17:319.
Gresham RB. The freeze-dried cortical bone homograft: a roentgenographic and histologic evaluation. Clin Orthop. 1964;37:194.
Gross AE, Langer F, Houpt J, Pritzker K, Friedlander CE. The allotransplantation of the partial joints in the treatment of osteoarthritis of the knee. Transplant Proc. 1976;8(Suppl I):129.
Gross AE, Langer F, Silverstein EA, Falk R, Falk J. The allotransplantation of the partial joints in the treatment of osteoarthritis of the knee. Clin Orthop. 1975;108:7–14.
Gross A, Mc Kee N, Pritzker K, Langer F. Reconstruction of skeletal deficit at the knee. Clin Orthop. 1983;174:96–106.
Guilleminet S, Dubost-Perret JA. Utilisation d’os hétérogènes réfrigérés en chirurgie humaine. Lyon Chir. 1952;47(1):57.
Hedde C, Postel M, Kerboul M, Courpied JP. La réparation du cotyle par homogreffe osseuse conservée au cours des révisions de prothèse totale de hanche. Rev Chir Orthop. 1986;72:267–76.
Heiple KG, Chase SW, Herndon CH. A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg. 1963;45A:1593.
Hiky V, Mankin HJ. Radical resection and allograft replacement in the treatment of bone tumors. J Jpn Orthop Assoc. 1980;54:475.
Houff SA, Burton RC, Wilson RW, et al. Human-to-human transmission of rabies virus by corneal transplant. N Engl J Med. 1979;300:603.
Huten D. Utilisation des allogreffes osseuses dans les reconstructions fémorales au cours des reprises de prothèse totale de hanche. Rev Chir Orthop. 1988;74:122–4.
Hyatt GW, Butler MC. Bone grafting. The procurement storage and clinical use of bone homograft. In: America Association of Orthopeadic Sugeons: Instructional courses lectures, vol. 14. Ann Arbor, Mich: J.W. Edwards Co; 1957. p. 343.
Inclan A. L’emploi des greffes osseuses conservées en Orthopédie. J Bone Joint Surg. 1942;26:81–96.
Inclan A. Use of preserved bone graft in orthopeadic surgery. J Bone Joint Surg. 1942;26:81.
James JIP. Tuberculosis transmitted by banked bone. J Bone Joint Surg. 1953;35B:578.
Judet J, Aviset A. Homogreffes provenants de la banque d’os. Mem Acad Chir N. 1948;27–8:671.
Judet H, Padovani JP. Transplantation d’articulation complète. Rev Chir Orthop. 1983;67:359–60.
Koskinen EV, Salenius P, Alho A. Allogeneic transplantation inlow-grade malignant bone tumors. Acta Orthop Scand. 1979;50:129.
Kossowska-Paul B. Studies on the regional lymph node plastic reaction evoked by allogeneic grafts of fresh and preserved bone tissue. Bull Acad Polon Sci. 1966;14:651.
Kruez FP, Hyatt GW, Turner TC, Basset al. The preservation and clinical use of freeze-dried bone. J Bone Joint Surg. 1951;33AA:863.
Langer F, Czitrom A, Pritzker KP, Gross AE. The immunogenicity of fresh and frozen allogeneic bone. J Bone Joint Surg. 1975;57A:216.
Lee EH, Langer F, Halloran P, Gross AE, Ziv I. The effect of major and minor histocompatibility differences on bone transplant healing in inbred mice. Trans Orthop Res Soc. 1979;4:60.
Lee EH, Langer F, Halloran P, Gross AE, Ziv I. The immunology of osteochondral and massive allografts. Trans Orthop Res Soc. 1979;4:61.
Lexter E. Die verwendung der freien knochenplastik nebst versuchen über gelenkversteifung und gelenktransplantation. Arch Klin Chir. 1908;86:939.
Lexter E. Joint transplantation and arthroplasty. Surg Gynecol Obstet. 1925;40:782.
Locht R, Gross A, Langer F. Late osteochondral allograft resurfacing for tibia plateau fractures. J Bone Joint Surg Am. 1984;66:328–35.
Macewen W. Observations concerning transplantation of bone. Illustrated by case of inter-human osseous transplantation, where by over two-thirds of shaft of a humerus was restored. Pro R Soc Lond. 1881;32:232.
Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW. Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer. 1983;50:613.
Mankin HJ, Doppelt SH, Tomford WW. Clinical experience with allograft implantation. Clin Orthop. 1983;174:69–86.
Mankin HJ, Fogelson FS, Trasher AZ, Jaffer F. Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med. 1976;294:1247.
Marsh B, Flynn L, Enneking W. Immunologic aspects of osteosarcoma and their application to therapy, a preliminary report. J Bone Joint Surg. 1972;54A:1367.
Merle D’Aubigne R. A propos de la résection pour tumeurs du genou. Rev Chir Orthop. 1963;67:359–60.
Meyers MH, Chatterjee SN. Osteochondral transplantation. Surg Clin North Am. 1978;58:429.
Mnaymneh W, Emerson RH, Brajao F, Head WC, Malinin TI. Massive allografts in salvage revision of failed total knee arthroplasties. Clin Orthop. 1990;269:144–53.
Musculo DL, Kawai S, Ray RD. Cellular and humoral immune response analysis of bone-allografted rats. J Bone Joint Surg. 1976;58A:826.
Nimelstein SH, Hotti AR, Homan HR. Transformation of a histocompatibility immunogen into a tolerogen. J Exp Med. 1973;128:723.
Ollier L. Traité expérimental et clinique de la régénération des os. Paris: Victor Masson & fils; 1867.
Ottolenghi CE. Massive osteo and osteo-articular bone grafts: technic and results of 62 cases. Clin Orthop. 1972;87:156.
Parrish FF. Allograft replacement of all part of the end of a long bone following excision of a tumor: report of twenty-one cases. J Bone Joint Surg. 1973;55A:1.
Pelkers R, Friedlander G, Markham T. Biomechanical properties of bone allografts. Clin Orthop. 1983;174:54–7.
Penn I. The incidence of malignancies in transplant recipients. Transplant Proc. 1975;7(2):323.
Poitout D. Greffes utilisées pour reconstruire l’appareil locomoteur. Paris: Masson; 1986.
Poitout D. Future of bone allografts in massive bone resection for tumor. Presse Med. 1996;25(11):527–30.
Poitout D. Reconstruction du cotyle et de l’hémibassin par allogreffe ou prothèse méttalique massive sur mesure. 73ème Réunion Annuelle de la S.O.F.C.O.T. – Paris les 10–13 novembre 1998. Revue de chirurgie Orthopédique. 1998;84(218):120–1.
Poitout D. Allografts of the patella and extensor apparatus. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 42–9.
Poitout D. Allotraplanto della rotula e dell’apparato estensor. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 42–9.
Poitout D. Banche d’osso: aspetti tecnici criopreservazione di allotraplanti osteocartilagineo. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 178–9.
Poitout D. Bone bank: technical aspects of cryopreservation osteocartilaginous grafts. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 178–9.
Poitout D. Conservation et utilisation de l’os de banque. Cahier d’enseignement de la S.O.F.C.O.T N°23. Expansion scientifique. Conférence 1985. p. 157–77.
Poitout D. Knee reconstruction prosthesis incorporating a large allograft. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1995. p. 145–51.
Poitout D. L’os biomateriaux. « Bulletin de l’Académie de Nationale de médecine ». Communication à l’Académie Nationale de Médecine. Paris, 14 mars 1995. 1995;179;3:517–36.
Poitout D. Les greffes de l’appareil locomoteur. Académie de Chirurgie (Paris, 10 avril 1996). « Mémoire de l’académie de Chirurgie ». 1996.
Poitout D. Les reconstructions de cotyle après chirurgie iterative de la hanche. (A propos de 37 cas). Académie Nationale de Médecine. Paris, 5 mars 1996. Bulletin de l’Académie de Nationale de médecine . 1996;180;3:515–31.
Poitout D. Protesi di ricostruzione di ginocchio con allotraplanto massivo. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 145–51.
Poitout D, Bernat M, Martin G, Tropiano P. Indications des greffes osteocartilagineuses massives en traumatologie du genou. Acta Orthopedica Belgica. 1996;62(6):59–65.
Poitout D, Bernat M, Martin G, Tropiano P. Indications des greffes osteo-cartilagineuses massives en traumatologie du genou. Acta Orthopaedica Scandinavica. Edition Scandinavian University Press, vol. 62, 1997; suppl. 1.
Poitout D, Bernat M, Moulene JF, Tropiano P. Allogreffes de cotyle et d’hémi-bassin. A propos de 37 cas. 71ème Réunion Annuelle de la S.O.F.C.O.T. – Paris les 12–15 novembre 1996. Revue de chirurgie Orthopédique. 1996;87(152):100.
Poitout D, Bernat M, Moulene JF, Tropiano P. Devenir des fractures du col du fémur. 71ème Réunion Annuelle de la S.O.F.C.O.T. – Paris les 12–15 novembre 1996. Revue de chirurgie Orthopédique. 1996;87(153):100–1.
Poitout D, Bernat M, Moulene JF, Tropiano P. Indications for cryopreserved allografts in tumoral pathology. Eur J Orthop Surg Traumatol. 1997;7:100–4.
Poitout D, Bernat M, Moulene JF, Tropiano P. Massive HIP prothese ensheated by allografts. Eur J Orthop Surg Traumatol. 1997;7:123–6.
Poitout D, Bernat M, Moulene JF, Tropiano P. Allogreffes osteochondrales ou prothèses articulaires en chirurgie traumatologique ou oncologique du genou. 71ème Réunion Annuelle de la S.O.F.C.O.T. – Paris les 12–15 novembre 1996. Revue de chirurgie Orthopédique. 1996;69–70, 87–99.
Poitout D, Dubousset JF, Tomeno B. Arthrectomie monobloc du genou. Revue de Chirurgie Orthopédique. 1995;81–6:565, Paris.
Poitout D, Lempadakis M, Bernat M, Lecoq C, Martin G, Aswad R. Secondary internal osteosynthesis after fixation for recent or lower limb. Revue de chirurgie orthopédique Réparatrice. 1996;82(2):137–44.
Poitout D, Lempidakis M. Artificial ligament repairs. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 76–85.
Poitout D, Lempidakis M. Legamentoplastiche artificiali. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 76–85.
Poitout D, Lempidakis M, et Loncle X, Bernat M. Les sarcomes ostéogeniques de l’extrêmité inférieur du fémur. Techniques de reconstruction – L’avenir. « Revue de Chirurgie Orthopédique », Communication à l’Académie Nationale de Chirurgie, Paris le 29 mars 1995. 1995;566:81–6.
Poitout D, Lempidakis M, et Loncle X, Bernat M. Reconstructions massives du cotyle et du fémur proximal. Académie de Chirurgie (Paris, 1994). « Mémoire de l’académie de Chirurgie » Tome N°5, 1994–5;120.
Poitout D, Lempidakis M, et Loncle X. Allotraplanto osteo-cartilagineo massive dell’estremita inferiore del femore. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 164–9.
Poitout D, Lempidakis M, et Loncle X. Allotraplanto osteocartilagineo massivo dell’estremita superiore della tibia. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 170–7.
Poitout D, Lempidakis M, et Loncle X. Osteocartilaginous graft of the lower extremity of the femur. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 164–9.
Poitout D, Lempidakis M, et Loncle X. Osteocartilaginous graft of the upper tibia. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 170–7.
Poitout D, Loncle X. Legamento crociato posteriore. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 86–8.
Poitout D, Loncle X. Posterior cruciate ligament. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 86–8.
Poitout D, Lu J, Huang ZW, Tropiano P, Clouet D’Orval B, Remusant M, Dejou J, Proust JP. Human biological reactions at the interface between bone tissues and poly-methylmethacryalate cement. J Mater Sci Mater Med. 2000;13:803–9.
Poitout D, Nandiegou Y, Lempidakis M. Artificial ligament repair. Atlas of open knee surgery. London/Paris: Edition Chapman & Hall; 1996. p. 89–93.
Poitout D, Nandiegou Y, Lempidakis M. Legamentoplatica artificiale. Atlante di technica chirurgica del ginocchio. Milan: Edition Masson; 1995. p. 89–93.
Poitout D, Novakovich G. Allogreffes et banque d’os. Encyclopédie Médico-chirurgicale (Paris-France), appareil locomoteur 14015AIO, 1986;5–6.
Poitout D, Ozoux P. Intra-articular repair of the posterior cruciate ligament using either semitendinosus or gracilis tendons (Lindenmann’s operation). Atlas of open knee surgery. Edition Chapman & Hall; 1996. p. 94–5.
Poitout D, Tropiano P. Les reconstitutions du cotyle après chirurgie iteractive de la hanche – A propos de 37 cas. Bull Acad Natl Med. 1996;180(3):515–31.
Poitout D, Tropiano P, Bernat M, Loncle X, Martin G. Greffes articulaires, mythe ou réalité? Entretiens de Bichat 1995. Paris 25–30 septembre 1995. Chirurgie-Spécialité. 1995;43–6.
Poitout D, Tropiano P, Bernat M, Moulene JF. Reconstruction massive de cotyle et du fémur proximal. Les Arcs, 20–25 janvier 1996. «Eur J Orthop Surg Traumatol». 1996;6:271–7.
Pool AR, Reiner A, Choi H, Rosenberg LC. Immunological studies of proteoglycan subunit from bovine and human cartilage. Trans Orthop Res Soc. 1979;4:55.
Pujet J, Utheza G. Reconstructionde l’os iliaque à l’aide du fémur homoilatéréal après résection pour tumeur pelvienne. Rev Chir Orthop. 1986;72:151–5.
Rodrigo JJ. Distal rat femur allografts: a surgical model for induction of humoral cytotoxic antibodies. Trans Orthop Res Soc. 1977;2:265.
Rodrigo JJ, Fuller TC, Mankin HJ. Cytotoxic HL-A, antibodies in patient with bone and cartilage allografts. Trans Orthop Res Soc. 1976;1:131.
Roy-Camille R, Laugier A, Ruyssen S, Chenal C, Bisserie M, Pene F, Saillant G. Evolution des greffes osseusescortico-spongieuses et radiothérapie. Rev Chir Orthop. 1981;67:599–608.
Sadler AM Jr, Sadler BL. Providing cadaver organs: three legal alternatives. Hastings Center Studies I. 1973;14.
Sadler Jr AM, Sadler BL, Stason EB, Stickel DL. Transplantation – A case for consent. N Engl J Med. 1969;280:862.
Sagi S, Turianskyj FH, Gyenes L. Immunogenicity of soluble murine histocomptabilicity antigens. Immunol Commun. 1974;3:85.
Salama R. Xenogeneic bone grafting in humans. Clin Orthop. 1983;174:113–21.
Schachar NS, Friedlander GE, Mankin HJ. Bone transplantation. In Slavin S, editor. Organ transplantation: present state, future goals. Amsterdam: Elsevier/North-Holland Biomedical Press B.V. 1978 (in press).
Schachar NS, Fuller TC, Wadsworth PL, Henry WB, Mankin HJ. A feline model for the study of frozen osteoarticular allografts. Development of lymphocytotoxic antibodies in allograft recipients. Trans Orthop Res Soc. 1978;3:131.
Schachar NS, Mankin HJ, Wadsworth PL, Henry WB, Castronovo FP. A feline model for the study of frozen osteoarticular allografts. I. Quantitative assessment of cartilage viability and bone healing. Trans Orthop Res Soc. 1978;3:130.
Sell KW, Friedlander GE, editors. Tissues banking for transplantation. New-York: Grune & Stratton, Inc; 1976.
Sell KW, Friedlander GE, Strong DM. Immunogenicity and freeze-drying. Cryoimmunology. 1976;17:187.
Shneider JR, Bright RW. Anterior cervical fusion using preserved bone allografts. Transplant Proc. 1976;8(suppl):73.
Shutkin NM. Homologous-serum hepatitis following use of refrigerated bone-bank bone: report of case. J Bone Joint Surg. 1954;36A:160.
Solomon L. Bone Grafts. J Bone Joint Surg Am. 1991;73-B:706–7.
Spence KF, Sell KW, Brown RH. Solitary bone cyst: treatment with freeze-dried cancellous bone allograft. J Bone Joint Surg. 1969;51A:87.
Stockley I, Mc Auley JP, Gross AE. Allograft reconstruction in total knee arthroplasty. J Bone Joint Surg Am. 1992;74-B:393–7.
Syftestad G, Urist M. Bone aging. Clin Orthop. 1982;162:288–97.
Takagi K, Urist M. The reaction of the dura to bone morphogenetic protein (BMP) in repair of skull defects. Ann Surg. 1982;196:100–9.
Takagi K, Urist M. The role of bone marrow in bone morphogenetic protein-induced repair of femoral massive diaphyseal defects. Clin Orthop. 1982;171:224–30.
Takami H, Doi T, Ninomiya S. Reconstruction of a large tibial defect with a free vascularized fibular graft. Arch Orthop Surg. 1984;102:203–5.
Tavernier. Sur les greffes d’os tué. Lyon Chir., 1922, séance du 17 novembre 1921. Utilisation d’os purum. Lyon Chir 1930.
Tomford WW, Fredricks GR, Mankin HJ. Cryopreservation of intact articular cartilage. Trans Orthop Res Soc. 1982;7:176.
Tomford WW, Fredricks GR, Mankin HJ. Cryopreservation of isolated chondrocytes. Trans Orthop Res Soc. 1982;6:100.
Tomford WW, Mankin HJ, Doppelt S. Bone bank procedures. Clin Orthop. 1983;174:15–21.
Tomford WW, Starkweather RJ, Golman MH. A study of the clinical incidence of infection in the use of banked allograft bone. J Bone Joint Surg. 1981;63A:244.
Trentham DE, Townes AS, Kang AH, David JR. Humoral and cellular sensitivity to collagen in type II. Collagen induced arthritis in rats. J Clin Invest. 1978;61:89.
Tuffier. Des greffes chirurgicales chez l’homme. Bull et Mém Soc Chir 36, 1983, Paris 1910.
Urist MR. Practical applications of basic research on bone graft physiology. In: AAOS: Instructional Course Lectures, vol. 25:1. St Louis: The C.V. Mosby Co; 1976.
Urist MR, Delange R, Finermann G. Bone cell differentiation and growth factors. Science. 1983;220:680–6.
Urist MR, Mikulski A, Boyd SD. A chemosterilized antigen-extracted autodigested alloimplant for bone banks. Arch Surg. 1975;110:416.
Urist MR, et al. Human bone morphogenetic protein. Proc Soc Exp Biol Med. 1983;173:194–9.
Volkov M. Allotransplantation of joints. J Bone Joint Surg Br. 1970;52B:49–53.
Volkov M, Imamaliyev AS. Use of allogenous articular bone implants as substitutes for autotransplants in adult patients. Clin Orthop. 1976;114:192.
Weiland A, Moore R, Daniel R. Vascularized bone autografts. Clin Orthop. 1983;174:87–95.
Weislander J, Heinegard D. Immunochemical analysis of cartilage proteoglycans: antigenic determinants of substructures. Biochem J. 1979;179:35.
Wilson PD. Follow-up study of the use of refrigerated homogenous bone transplants in orthopaedic operations. J Bone Joint Surg. 1951;33A:307.
Wilson RE, Penn I. Fate of tumors transplanted with a renal allograft. Transplant Proc. 1975;7(2):327.
Wittbjer J, Palmer B, Rohlin M, Thorngren K. Osteogenetic activity in composite grafts of demineralized compact bone and marrow. Clin Orthop. 1983;173:229–38.
Yablon I, Brandt KD, Delellis RA. The antigenic determinants of articular cartilage: their role in the homograft rejection. Trans Orthop Res Soc. 1977;2:90.
Yablon I, Copperband S, Covall D. Matrix antigens in allografts. Clin Orthop. 1982;168:243–51.
Yamane K, Nathenson SG. Biochemical similarity of papain-solubilized H-2d, alloantigens from tumor cells and from normal cells. Biochemistry. 1970;9:4743.
Zaleske D, Ehrlich M, Piliero C, May J, Mankin HJ. Growth plate behavior in whole joint replantation in the rabbit. J Bone Joint Surg Am. 1982;64:249–57.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Appendix
Appendix
Recommendations for Setting Up a Tissue Bank for the Locomotor Apparatus
These recommendations are those used by the Blood Transfusion Center of Marseilles to, among other things, preserve bone, cartilage, and ligament grafts.
The Organization of a Tissue Bank
General
The need for:
-
a tissue removal team approved by the Ministry, a geographical location for treating, storing, and making the tissue available.
Equipment
A preservation department equipped with storage tanks or apparatus, a temperature-lowering programmer indispensable for preserving bone, cartilage, and ligament tissue.Laboratories experienced in the following quality controls:
-
donor control,
-
tissue control,
-
validation of the preservation techniques.
Personnel
At the hospital:
-
the person in charge of tissue removal checks that removal from a subject in a state of brain death is in line with the regulations,
-
the surgical teams remove and treat the tissue.
At the tissue bank:
-
the bank receives the tissue,
-
the technical staff at the bank treats the tissue,
-
the laboratories perform viral serological tests on the donor and a bacteriological examination of the tissue removed,
-
the bank’s medical supervisor oversees everything.
Techniques
For each tissue, all the technical aspects of the removal, treatment, storage, quality control, distribution, and results of examinations are recorded in a manual updated regularly.
Information
Information on the donor:
-
Identity, sex, age;
-
Radiography of the tissue if necessary;
-
Cause of death;
-
Medical history;
-
ABO blood group and HLA if known;
-
Operating protocol of removal, therapies used;
-
Results of any laboratory examinations;
-
Results of the control examinations;
-
Tissue removal center and department.
Information on the host:
-
Identity, sex, age;
-
Origin of the graft;
-
Attribution criteria;
-
Identification of the use of the graft, site and date;
-
Possible response to implantation of the graft;
-
ABO blood group and HLA if known;
-
Results of the culture at the time of the graft;
-
Note any departure from the guidelines for handling and reconstitution;
-
An estimate of the clinical results.
Quality Control
Each tissue preservation department has to take part in the development of the methods which make it possible to evaluate the indications of the tissue grafts preserved. Periodical monitoring of the bacteriological status has to be practiced, checking, before they are dispatched, at least 5 % of the grafts every 6 months and more if problems with bacterial contamination are suspected.
Tissue Removal
General Ethical and Legal Considerations
In general, acceptable sources of tissues are cadavers less than 6 h after circulation has stopped, patients in a state of brain death, and patients who have had part of their tissue removed for therapeutic purposes (femoral head).The Caillavet law considers a donor to be any person who, during his lifetime, did not express any opposition to removal of his or her tissue. It is difficult, in practice, not to consider the pain suffered by those close to the person they have lost.
Selection Criteria
These vary depending on the tissue removed. Age may be a limiting factor following the use which will be made of the tissue taken. For cartilage in particular, it seems to be necessary to graft only normal joint surfaces which have been taken from healthy subjects.
Tissue may be removed from the cadaver for 5 h after his or her death if it is kept at ambient temperature and for approximately 12 h if the cadaver is stored at 4 °C immediately after death. The tissue removed from a live patient can be placed in a container, closed immediately and refrigerated at 4 °C. A valid preservation technique can be considered to be up to 12 h after the tissue has been removed and stored at the preservation temperature.
A medical history of the donor has to be sent. Potential donors will be excluded if their current medical history mentions:
-
developing septicemia,
-
a localized infection in the tissue to be removed,
-
a slowly developing viral episode
-
malignant neoplasia except for most of the cerebral tumors,
-
the existence of active hepatitis or unexplained jaundice,
-
systemic disease,
-
a patient belonging to the risk groups,
-
heavy irradiation on risk groups,
-
treatment with drugs which are toxic to the tissue to be removed.
Laboratory tests have to be performed on the blood of the cadaver or on the live donor:
-
a test for the hepatitis B virus,
-
a test for syphilis,
-
a test for HIV antibodies,
-
the transaminase levels,
-
a test for anti-HBc antibodies,
-
a test for anti-HCV antibodies,
-
a test for anti-HTL V1 and anti-HTL V2 antibodies
-
a test for anti-CMV antibodies.
The erythrocyte blood groups and tissue groups should be used and a serum bank should be set up.
Wherever possible, the tissue should be removed under sterile conditions in an operating theatre. If the allografts are removed in a non-sterile manner, it should be ensured that effective sterilization techniques can be used without damaging the tissue structure.
If a collecting medium is used, it has to be sterile and physiological.
If antibiotics are used, the bacterial cultures have to be grown before they are added and the type of antibiotics has to be clearly recorded. A final bacteriological check is recommended before the tissues are dispatched.
Fragments of tissues to be grafted have to undergo bacteriological and fungal studies using current methods and media. Cultures of the donor blood have to be carried out when the tissue is removed as well as a urine culture and possibly also a culture of a pleural effusion.
Secondary sterilization. If it is carried out, the biological and biochemical integrity of the graft has to be maintained. The methods used for decontaminating surfaces are acceptable if only the surface can be contaminated.
Preservation and Storage
The methods used to preserve and store tissue allografts vary according to the type of tissue and the clinical application in which they are included. Although the optimum methods have not been defined, the best for long-term preservation would appear to be preservation at very low temperatures (−80 °C). Continuous monitoring of the temperature may be necessary. Storage for 12 h at the most at 4 °C may be practiced from the time the tissue was removed. Only materials which are resistant to low temperatures are suitable for this type of preservation. They have to be sterile. The culture media may vary and have to be defined for each type of cell. Precautions have to be taken to check the persistence of the activity of the cells being cultured and for the absence of contamination.
Rights and permissions
Copyright information
© 2016 Springer-Verlag London
About this chapter
Cite this chapter
Poitout, D.G., de Gorce, Y.N. (2016). Bone Banks: Technical Aspects of the Preparation and Preservation of Articular Allografts. In: Poitout, D. (eds) Biomechanics and Biomaterials in Orthopedics. Springer, London. https://doi.org/10.1007/978-1-84882-664-9_7
Download citation
DOI: https://doi.org/10.1007/978-1-84882-664-9_7
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-84882-663-2
Online ISBN: 978-1-84882-664-9
eBook Packages: MedicineMedicine (R0)