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Intra-operative washing of morcellised bone allograft with pulse lavage: how effective is it in reducing blood and marrow content?

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Abstract

The use of unprocessed bone carries a risk of transmission of blood borne diseases. Although models of infectivity are unproven, a theoretical risk of transmission of variant Creutzfeld-Jakob Disease, a human prion disease, exists as probable blood borne transmission has been reported in three cases. The aim of our study was to determine the effectiveness of standard operating theatre pulse lavage in removing protein, fat and double stranded Deoxyribonucleic acid (dsDNA) from morcellised bone allograft. Twelve donated femoral heads were divided into halves and milled into bone chips. One half of the bone chips were washed with pulse lavage, whereas, the other half acted as control. In order to determine the amount of protein, fat and dsDNA present in the washed and unwashed samples, a validated multistep washing protocol was used. Using the validated technique, simple intra-operative washing of morcellised unprocessed bone allograft removed a significant amount of the protein (70.5%, range: 39.5–85%), fat (95.2%, range: 87.8–98.8%) and DNA (68.4%, range: 31.4–93.1%) content. Intra-operative washing of morcellised bone allograft with pulse lavage may thereby reduce the theoretical risk of prion and other blood borne disease transmission. Combined with the known improved mechanical characteristics of washed allograft, we would recommend pulse lavage as a routine part of bone allograft preparation.

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References

  • Board TN, Brunskill S, Doree C, Hyde C, Kay PR, Meek RD, Webster R, Galea G (2009) Processed versus fresh frozen bone for impaction bone grafting in revision hip arthroplasty. Cochrane Database Syst Rev 7(4):CD006351

    Google Scholar 

  • Brown P, Preece M, Brandel JP, Sato T, McShane L, Zerr I, Fletcher A, Will RG, Pocchiari M, Cashman NR, d’Aignaux JH, Cervenáková L, Fradkin J, Schonberger LB, Collins SJ (2000) Iatrogenic Creutzfeld-Jakob disease at the millennium. Neurology 55:1075–1081

    Google Scholar 

  • Campbell DG, Li P, Stephenson AJ, Oakeshott RD (1994) Sterilisation of HIV by gamma irradiation. A bone allograft model. Int Orthop 18:172–176

    Article  PubMed  CAS  Google Scholar 

  • Conrad EU, Gretch DR, Obermeyer KR, Moogk MS, Sayers M, Wilson JJ, Strong DM (1995) The transmission of hepatitis-C virus by tissue transplantation. J Bone Joint Surg Am 77A:214–224

    Google Scholar 

  • CDC (2001) Notice to readers: unexplained deaths following knee surgery. Minnesota MMWR 50(46):1035–1036

    Google Scholar 

  • De Paula CA, Truncale KG, Gertzman AA, Sunwoo MH, Dunn MG (2005) Effects of hydrogen peroxide cleaning procedures on bone graft osteoinductivity and mechanical properties. Cell Tissue Bank 6:287–298

    Article  Google Scholar 

  • Dunlop DG, Brewster NT, Madabhushi SP, Usmani AS, Pankaj P, Howie CR (2003) Techniques to improve the shear strength of impacted bone graft: the effect of particle size and washing of the graft. J Bone Joint Surg Am 85:639–646

    Google Scholar 

  • Eastlund T, Strong DM (2003) Infectious disease transmission through tissue transplantation. In: Advances in tissue banking, vol 7. World Scientific Publishing Company, Singapore. pp 51–132

  • Gibbs CJ, Gajdusek DC, Latarjet R (1978) Unusual resistance to ionizing radiation of the viruses of Kuru, Creutzfeld-Jakob disease and Scrapie. Proc Natl Acad Sci 75:6268–6270

    Article  PubMed  Google Scholar 

  • Halliday BR, English HW, Timperley AJ, Gie GA, Ling RS (2000) Femoral impaction grafting with cement in revision total hip replacement: evolution of the technique and results. J bone Joint Surg Br 82:103–107

    Google Scholar 

  • Health Protection Agency (2006) New case of transmission of associated variant CJD. Commun Dis Report Week 16:2

    Google Scholar 

  • Hirn MYJ, Salmela PM, Vuento RE (2001) High-pressure saline washing of allografts reduces bacterial contamination. Acta Orthop Scand 72:83–85

    Article  PubMed  CAS  Google Scholar 

  • Kwong FNK, Ibrahim T, Power RA (2005) Incidence of infection with the use of non-irradiated morcellised allograft bone washed at the time of revision arthroplasty of the hip. J Bone Joint Surg [Br] 87: 1524–1526

    Google Scholar 

  • Llewelyn CA, Hewitt PE, Knight RS, Amar K, Cousens S, Mackenzie J, Will RG (2004) Possible transmission of variant Creutzfeld-Jakob disease by blood transfusion. Lancet 363:417–421

    Article  PubMed  CAS  Google Scholar 

  • Lomas R, Drummond O, Kearney JN (2000) Processing of whole femoral head allografts: a method for improving clinical efficacy and safety. Cell Tissue Bank 1:193–200

    Article  PubMed  Google Scholar 

  • Lowry OH, Rosebrough NJ, Farr L, Randall RJ (1951) Protein measurement with the Folin Phenol reagent. J Biol Chem 193:267–275

    Google Scholar 

  • Moreau MF, Gallois Y, Baslé M-F, Chappard D (2000) Gamma irradiation of human bone allografts alters medullary lipids and releases toxic compounds for osteoblast-like cells. Biomaterials 21:369–376

    Article  PubMed  CAS  Google Scholar 

  • Nguyen H, Morgan DAF, Forwood MR (2007a) Sterilisation of allograft bone: effects of gamma irradiation on allograft biology and biomechanics. Cell Tissue Bank 8:93–105

    Article  PubMed  Google Scholar 

  • Nguyen H, Morgan DAF, Forwood MR (2007b) Sterilisation of allograft bone: is 25 kGy the gold standard for gamma irradiation? Cell Tissue Bank 8:81–91

    Article  PubMed  Google Scholar 

  • Peden AH, Head MW, Ritchie DL, Bell JE, Ironside JW (2004) Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient. Lancet 364:527–529

    Article  PubMed  Google Scholar 

  • Robinson DE, Lee MB, Smith EJ, Learmonth ID (2002) Femoral impactions grafting in revision hip arthroplasty with irradiated bone. J Arthroplasty 17:834–840

    Article  PubMed  CAS  Google Scholar 

  • Schreurs BW, Arts JJ, Verdonschot N, Buma P, Slooff TJ, Gardeniers JW (2005) Femoral component revision with use of impaction bone-grafting and a cemented polished stem. J Bone Joint Surg Am 87:2499–2507

    Google Scholar 

  • Simonds RJ (1993) HIV transmission by organ and tissue transplantation. AIDS 7(Suppl 2):S35–S38

    Article  PubMed  Google Scholar 

  • Simonds RJ, Holmberg SD, Hurwitz RL, Coleman TR, Bottenfield S, Conley LJ, Kohlenberg SH, Castro KG, Dahan BA, Schable CA, Rayfield MA, Rogers MF (1992) Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. New Engl J Med 326:726–732

    Article  PubMed  CAS  Google Scholar 

  • Singer VL, Jones LJ, Yue ST, Haugland RP (1997) Characterisation of Picogreen reagent and development of fluorescence-based solution assay for double stranded DNA quantitation. Annal Biochem 249:228–238

    Article  CAS  Google Scholar 

  • The Feeding Stuffs (1970) (Sampling and Analysis) Regulations (as amended) statutory instrument 1985. No. 1119, HMSO, London BS4401 Part 4

  • Thoren K, Aspenberg P (1995) Ethylene oxide sterilization impairs allograft incorporation in a conduction chamber. Clin Orthop Relat Res 318:259–264

    PubMed  Google Scholar 

  • Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77:1742–1754

    Google Scholar 

  • van der Donk S, Weernink T, Burma P, Aspenberg P, Sloof TJ, Schreurs BW (2003) Rinsing morselised allografts improves bone and tissue ingrowth. Clin Orthop Relat Res 408:302–310

    Article  PubMed  Google Scholar 

  • Yates P, Thomson J, Galea G (2005) Processing of whole femoral head allografts: validation methodology for the reliable removal of nucleated cells, lipid and soluble proteins using a multi-step washing procedure. Cell Tissue Bank 6:277–285

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

None of the authors received financial support for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK

    T. Ibrahim, A. Qureshi & R. A. Power

  2. Scottish Blood Transfusion Services–Tissues and Cells Directorate, Ellens Glen Road, Edinburgh, EH17 7QT, UK

    T. A. McQuillan & G. Galea

  3. Scottish Blood Transfusion Services–Tissues and Cells Directorate, Regional Transfusion Centre, Foresterhill Road, Aberdeen, AB25 2ZW, UK

    J. Thomson

  4. Division of Orthopaedic Surgery, University of Leicester, Leicester General Hospital, Gwendolen Road, Leiceseter, LE5 4PW, UK

    T. Ibrahim

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  1. T. Ibrahim
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  2. A. Qureshi
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  3. T. A. McQuillan
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  4. J. Thomson
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  5. G. Galea
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  6. R. A. Power
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Correspondence to T. Ibrahim.

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Ibrahim, T., Qureshi, A., McQuillan, T.A. et al. Intra-operative washing of morcellised bone allograft with pulse lavage: how effective is it in reducing blood and marrow content?. Cell Tissue Bank 13, 157–165 (2012). https://doi.org/10.1007/s10561-011-9241-9

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  • DOI: https://doi.org/10.1007/s10561-011-9241-9

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