Summary
Massive bone allografts sterilised by radiation have been used in our hospital since 1985. The 164 consecutive reconstructions which we carried out before December 1990 were in equal part for tumour resections and revision arthroplasties associated with major bone defects. The allografts were used as intercalary or composite graft-prosthesis reconstructions. Fourteen (8.5%) skin sloughs or infections occurred, all but one after operations for malignant tumours. The grafts never appeared to be responsible. Infection after malignant tumour resection most commonly occurred at the knee when preoperative radiation had been used. Twenty-five reconstructions were performed in the presence of infection, which only recurred in one case. Twelve infections were treated, but 2 other patients died for other reasons within a year. One patient had to have an amputation and one had persistent infection. In the other cases, the infection healed. Only two debridements alone were successful. Removal of the graft and replacement with antibiotic-loaded cement was the most effective treatment.
Résumé
Les auteurs ont utilisé depuis 1985 des allogreffes massives radio-stérilisées. Des 164 reconstructions successives faites jusqu'à Décembre 1990, la moitié concernait des tumeurs et l'autre des reprises de prothèses avec dégâts osseux majeurs (excluant les petites reconstructions faites avec des têtes fémorales de banque). Il s'agissait de reconstructions intercalaires ou composites (allogreffe-prothèse). Quatorze nécroses cutanées ou infections ont été observées (8,5%). Toutes concernaient des reconstructions pour tumeurs malignes, sauf une, survenue après révision d'une prothèse initialement septique. Les greffes n'ont jamais paru être la cause de l'infection. Le risque septique s'est avéré plus important après résection tumorale et pourtant le rôle de la chimiothérapie n'a pu être prouvé. Des lambeaux de couverture auraient dû éviter les nécroses cutanées qui sont toutes survenues au genou. Vingt-cinq reconstructions ont été faites alors qu'il existait des antécédents d'infection; une seule a récidivé. Douze infections ont été traitées (deux malades étant décédés au cours de la première année d'une cause non infectieuse). Un patient ayant reçu une radiothérapie pré-opératoire a dû être amputé et une infection persiste après un nettoyage simple. Dans les autres cas, l'infection est apparemment guérie, le plus souvent après ablation de la greffe, remplacée temporairement par du ciment imprégné d'antibiotiques, avant reconstruction osseuse secondaire.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Basset AL, Packard AJ Jr (1959) A clinical essay of cathode ray sterilized cadaver bone grafts. Acta Orthop Scand 28: 198–211
Bright RW, Burchardt H (1983) Material properties of preserved cortical bone. In osteochondral allografts. Little Brown, Boston, pp 241–247
Campanacci M, Costas S (1979) Total resection of the distal femur or proximal tibia for bone tumors. J Bone Joint Surg [Br] 61: 455–463
Darbord JC, Laizier J (1987) A theoretical basis for choosing the dose in radiation sterilization of medical supplies. Intern J Pharmaceutics 37: 1–10
De Vries PH, Badgley CE, Hartman JT (1958) Radiation sterilization of homogenous bone transplants utilizing radioactive cobalt. J Bone Joint Surg [Am] 40: 187–203
Dick HM, Malinin TI, Mnaymneh W (1985) Massive allograft implantation following radical resection of high-grade tumors requiring adjuvant chemotherapy treatment. Clin Orthop 197: 88–95
Enneking WF, Eady JL, Burchardt H (1980) Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg [Am] 62: 1039–1058
Evrard J, Doyon F, Acar JF et al (1988) Two-day cefamandole versus five-day cephazolin prophylaxis in 965 total hip replacement. Intern Orthop 12: 69
Gitelis S, Heligman D, Quill G, Piaseki P (1988) The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasties. Clin Orthop 231: 62–70
Gristina AG, Costerton JW (1985) Bacterial adherence to biomaterials and tissues. J Bone Joint Surg [Am] 67: 264–273
Hernigou Ph, Delepine G, Goutallier D (1991) Infections après allogreffes osseuses massives dans la chirurgie des tumeurs osseuses des membres. Rev Chir Orthop 77: 6–13
Komender A (1976) Influence of preservation on some mechanical properties of human Haversian bone. Mater Med Pol 8: 13
Lord CF, Gebhardt MC, Tomford WW, Mankin HJ (1988) Infection in bone allografts: incidence, nature, treatment. J Bone Joint Surg [Am] 70: 369–376
Loty B (1988) Irradiation des allogreffes osseuses. Rev Chir Orthop 74: 109–159
Loty B (1992) Greffes osseuses: aspects fondamentaux et techniques de conservation en 1992. Cahiers d'enseignement de la SOFCOT, Conférences d'enseignement 1992, Expansion Scientifique, Paris, 211–237
Loty B, Courpied JP, Tomeno B, Postel M, Forest M, Abelanet R (1990) Radiation sterilized bone allografts. Intern Orthop 14: 237–242
Loty B, Postel M (1992) Allograft bone in major revision hip replacement surgery. In: J Oldor (ed) Bone implant grafting. Springer, London, pp 77–90
Malawer MM, McHale KA (1989) Limb sparing surgery for high-grade malignant tumors of the proximal tibia. Clin Orthop 239: 231–249
Mankin HJ, Doppelt S, Sullivan R, Tomford W (1982) Osteoarticular and intercalary allograft transplantation in the management of malignant bone tumors. Cancer 50: 613–630
Mc Donald DJ, Capanna R, Campanacci M (1990) Influence of chemotherapy on perioperative complications in limb salvage surgery for bone tumors. Cancer 65: 1509–1516
Merle d'Aubigné R, Dejouany JP (1958) Diaphysoepiphyseal resection for bone tumors at the knee. J Bone Joint Surg [Br] 40: 385–395
Merle d'Aubigné R, Méary R, Thomine JM (1966) La résection dans le traitement des tumeurs des os. Rev Chir Orthop 52: 305–324
Postel M, Loty B, Courpied JP, Tomeno B, Kerboull M (1991) Upper femur massive composite prostheses after tumor surgery. In: Limb salvage — major reconstructions in oncologic and nontumoral conditions. Springer, Berlin Heidelberg New York, pp 415–421
Power RA, Wood DJ, Tomford WW, Mankin HJ (1991) Revision osteoarticular allograft transplantation in weight-bearing joints. J Bone Joint Surg [Br] 73: 595–599
Roberts P, Chan D, Grimer RJ, Sneath RS, Scales JT (1991) Prosthetic replacement of the distal femur for primary bone tumours. J Bone Joint Surg [Br] 73: 762–769
Tomeno B, Istria R, Merle d'Aubigné R (1978) La résection arthrodèse du genou pour tumeur. Rev Chir Orthop 64: 323–332
Tomford WW, Thongphasuk J, Mankin HJ, Ferraro MJ (1990) Frozen musculoskeletal allografts: a study of the clinical incidence and causes of infection associated with their use. J Bone Joint Surg [Am] 72: 1137–1143
Triantafyllou N, Sotiropoulos E, Tryantafillou JN (1975) The mechanical properties of the lyophilized and irradiated bone grafts. Acta Orthop Belg suppl 1: 35–44
Turner TC, Basset CAL et al (1956) Sterilization of preserved bone grafts by high voltage cathode irradiation. J Bone Joint Surg [Am] 38: 862–884
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Loty, B., Tomeno, B., Evrard, J. et al. Infection in massive bone allografts sterilised by radiation. International Orthopaedics 18, 164–171 (1994). https://doi.org/10.1007/BF00192473
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00192473