Procedures of a bank of bones and aplicability of the grafts offered by such

Abstracts

Os autores demonstram neste estudo a viabilidade e funcionabilidade de um Banco de Ossos e a experiência da utilização durante os dezessete anos de sua criação. O objetivo deste estudo é demonstrar a importância da manutenção de um serviço de Banco de Osso, bem como mostrar suas utilidades nos diversos tipos de intervenções ortopédicas. Ficando demonstrado, o protocolo para obtenção de possíveis doadores, métodos para retirada e armazenagem desses ossos, e a sua utilização em diversos procedimentos ortopédicos.

Banco de Ossos; aloenxerto

ARTIGO ORIGINAL

Procedures of a bank of bones and aplicability of the grafts offered by such bank

Milton V. Roos^I; Antero Camisa Jr.^I; Alexandre Fróes Michelin^II

^IMédicos preceptores da residência médica do CEOP. Serviço de cirurgia do quadril

^IIMédico residente R₂ do CEOP

SUMMARY

The authors demonstrate in this study the viability and functionality of a Bank of Bones and the experience of the use during the seventeen years of your creation.

The objective of this study is to demonstrate the importance of the maintenance of a service of Bank of Bone, as well as to show your usefulness in the several types of orthopedical interventions. Being demonstrated, the protocol for the possible donors' obtaining, methods for retreat and storage of those bones, and your use in several orthopedical procedures.

Key Words: Bank of Bone, allografts.

INTRODUCTION

The use of homologous tissues for transplant is considerably increasing in the last decade. Improved surgical techniques, development of immunosupressive drugs and the global progress of the medicine, are making easier the use of several organs for transplant in patients, among them, for instance, kidneys, heart, lungs, liver cornea and bones.

The tentatives of using homologous bone graft started during the past century, but the appearance of infeccious processes due to the poor asseptic methods caused repeated failures, interrupted the tentatives of such procedure.

Some scattered tentatives of preserving bones occurred since Ollier discussed the concept in 1967, but the first joint effort to store bones for elective use and a description of the clinical efficacy were given by Inclan in 1942^{2, 3}. Verbeek & Kingma reported in 1953, the use of cortical bone graft in a Bank of Bones in Holand^{5, 9}. However, the technique of collection, treatment and storage of tissues were reported by Prof. Imamanaiev in Russia during the 60s⁴. Since then a large number of techniques for preservation and storage, besides laboratory research to preserve the biological quality of the graft, have been described.

In 1982 was created in Passo Fundo - RS - Brazil a Bank of Bones, being this the first institutional service in the country. Since then, the stored material has been systematically used, with success, in hundreds of complex cases of skeleton reconstruction.

To note, the first cases of femoral in Brazil were also performed in Passo Fundo - RS by the team of the Centro de Estudos Ortopédicos no Hospital São Vicente de Paulo.

The objective of this study is to demonstrate the importance of mantaining a bank of bones, the easiness of its construction and its great importance in the recovery of the bone tissue in several types of orthopedic interventions.

MATERIAL AND METHODS

Donors: Potential donors of bone are patients with brain death whose family gives consent for organ donation and healthy patients undergoing elective surgeries like hip arthroplasty, that will have parts of bone ressected.

The potential donors should attend the criteria to be accepted as donors. Such criteria are similar to those of the American Association of Tissue Banks for Bone Donation², for instance, no history of infection or potential infection before collection of the graft, hospitalization without fever, not more than 72 hours with respirator, free of chronic or infecto-contagious disease or chronic use of steroids.

Before the inclusion of these patients, a review of the medical history is performed to assure the absence of a pathology which could interfere in quality of the material for transplant. Blood also is collected for laboratory examinations (Table 1).

After that the collection of the desired elements is performed, which should be initiated first in the members and last in the hip, since this is a region more likely to be contaminated⁷. This procedure should follow strictely the rules for asseptia and antisseptia, usual in a conventional surgical procedure.

Used bones and Storage: Used bones are the femur, knee and iliac, but also can be collected umerus, ribs and other long bones. After collection of bones, cleaning of all soft tissues, muscular insertions and periosteum is performed. Then the bone is washed with saline plus gentamicin (80 mg in each 500 ml of saline) and stored ina hermetically closed sterile plastic container kept at the temperature of 20 ºC below zero in a regular freezer. At this temperature, the enzymes present in the tissues are still active and eventually will destroy the tissues^{7, 6}. Important to remember that the use of bones stored at this temperature for more than six months is not recommended.

Receivers: The use of allografts of bones from bone banks is indicated in patients who need repair of fractures, arthrodesis, reconstruction of cystic lesions after surgery of tumors, and also widely used in the reconstruction of hip in cases of revision of total hip arthroplasty ¹.

RESULTS

The use of homologous graft of bone from Bank of Bones shows advantages in many aspects, one of then is the absence of need for sacrifice of normal structures and absence of morbidity in the local of donation^{2, 3, 7}. Since there is no need for a secondary surgical approach, the consequence is that the risks of infection of the surgical wound are smaller, as well as the additional blood loss and prolonging of anesthesia time. To remember, the postoperative time is less problematic. Moreover, the use of this method offers to the orthopedist a large quantity of material and a variety of anatomical shapes. Other advantages would be its biocompatibility⁸, low immunogenicity and operational cost not too high.

DISCUSSION

The existence of a Bank of Bones in hospitals where orthopedic interventions are performed, will be, in short time, imperative, considered the benefits to those procedures that need large quantities and different anatomical shapes of bones. These are materials that can be stored in a Bank of Bones.

Figure 1

According to Tomford, W. W., MD et. All.⁷, the Bank of Bones is not an easy task, once it requires a legal environment of contribution not only from the families of donors but also from doctors, and facilities should be reliable. In old medical records and represented in pieces of art, since many centuries, the desire of repair or replace sick parts of a patient using a transplant of healthy tissues⁴, was present. However, the clinical use of human allografts has occurred more recently and has tried constantly to improve the surgical conditions aiming that the objectives are reached satisfactorily.

According to Friedlaender, G. E., MD, 1982², the technical innovations of the reconstructive orthopedic surgery and the progress of the methodology of bank of bones are not only closed linked but also are interdependents. Without the availability of massive allografts with adequate size and shape, these innovations would not be considered.

Figure 3

Mankin, H. J., MD, et. All.⁷, in a study about the clinical experience with implant of allograft, during more than 10 years, followed up 150 patients and demonstrated that surgical failures in tumor surgery was lower than 10% two or more years after surgery. These results were classified as good or excellent.

Many studies still have to be performed upon this matter, however, what is clear at this moment, supported by previous experience and literature, are the advantages and benefits of this kind of system and its consequent utilization.

CONCLUSION

The authors tried to demonstrate that implementation of a Bank of Bones, following legal rules and bioethical principles, is practical and functional, being of great importance when considered its aplicability and good results obtained in surgeries, as the quoted ones.

REFERENCES

Trabalho realizado no Centro de Estudos Ortopédicos de Passo Fundo.

Localizado à rua Paissandu, 928 Centro. Passo Fundo - RS

Fone: (54) 313-4333

• 01. AMSTUZ, H.C., MA, S.M., JINNAH, R.H. & MAI, L.: Revision Of Asseptic Loose Total Hip Artroplasties. Clin. Orthop 170:21, 1982.
• 02. FRIEDLAENDER, G.E.: Current Concepts Review Bone-Banking. J. Bone Joint Surgery 64-A: 307 - 311, 1982.
• 03. FRIEDLAENDER, G.E.: Current Concepts Review Bone-Banking. J. Bone Joint Surgery 69-A: 786 - 790, 1987.
• 04. IMAMALIEV A.: Transplante De Los Extremos Articulares. Tradução do russo, Moscou, 1971.
• 05. LINCLAU, L.: Deep Fronzen Cancellous Allografts In Orthopaedic Surgery. Acta Orthop. Belg 50:545 - 556, 1984.
• 06. STEFANI, A. E., OLIVEIRA, L. F. M. & FERNANDEZ, P.: Banco De Osso: UmMétodo Simplificado Ver. Brás. Ortop. 24/3: 66 - 72, 1989.
• 07. TOMFORD, W.W., DOPPELT, S.H., MANKIN, H. J. & FRIEDLAENDER, G. E.: Bone Bank Procedures. Clin. Orthop 174: 15 - 21, 1983.
• 08. URIST, M. R. & STRATES, B. S.: Bone Morphogenetic Proteins. J. Dent. Res. 30: 1.392 - 1.406, 1971.
• 09. VERBEEK, O. & KINGMA, M.I.: Citado por Linclau, L. 1984.

Publication Dates

• Publication in this collection
  07 May 2007
• Date of issue
  Sept 2000