Bone Allograft Safety and Performance

  • Calin S. Moucha
  • Regis L. Renard
  • Ankur Gandhi
  • Sheldon S. Lin
  • Rocky S. Tuan
Part of the Topics in Bone Biology book series (TBB, volume 3)


Bone allograft transplantation is a common practice; in the United States 650,000 procedures were performed in 1999, a 186% increase from 1990 [3]. This increase can be attributed to morbidities associated with bone autografts [6, 18, 30, 35, 59], the increased availability of bone allografts, and the expansion of these applications [9, 16, 21, 22, 29, 31, 42, 66]. A variety of musculoskeletal allografts are available for different reconstructive applications. Bone allograft is an alternative to autograft because it has osteoconductive properties, acts as a scaffold for bone growth, and induces bone formation by providing osteogenic factors, in addition to mesenchymal precursor cells, osteoblasts, and osteocytes. Although these properties are advantageous, the potential for the transmission of infectious diseases remains a great concern [1, 2, 4, 10, 12, 24, 26, 27, 32, 38, 49, 53].


Bone Graft Tissue Bank Human Immunodeficiency Virus Bone Allograft Human Immunodeficiency Virus Infection 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hepatitis C virus transmission from an antibodynegative organ and tissue donor-United States, 2000–2002 (2003) MMWR 53:273–276Google Scholar
  2. 2.
    Transmission of HIV through bone transplantation: case report and public health recommendations (1988) MMWR 37:597–599.Google Scholar
  3. 3.
    United States Census Bureau, Statistical Abstract of the United States (2001) No. 168 Organ Transplants and Grafts, 1990 to 2000.Google Scholar
  4. 4.
    Update: allograft-associated bacterial infections-United States (2002) MMWR 51:207–210.Google Scholar
  5. 5.
    Anderson MJ, Keyak JH, Skinner HB (1992) Compressive mechanical properties of human cancellous bone after gamma irradiation. J Bone Joint Surg Am 74:747–752.PubMedGoogle Scholar
  6. 6.
    Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060.PubMedCrossRefGoogle Scholar
  7. 7.
    Borchers RE, Gibson LJ, Burchardt H, Hayes WC (1995) Effects of selected thermal variables on the mechanical properties of trabecular bone. Biomaterials 16: 545–551.PubMedCrossRefGoogle Scholar
  8. 8.
    Boyce T, Edwards J, Scarborough N (1999) Allograft bone. The influence of processing on safety and performance. Orthop Clin North Am 30:571–581.PubMedCrossRefGoogle Scholar
  9. 9.
    Brantigan JW, Cunningham BW, Warden K, McAfee PC, Steffee AD (1993) Compression strength of donor bone for posterior lumbar interbody fusion. Spine 18:1213–1221.PubMedGoogle Scholar
  10. 10.
    Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus. An estimate of risk of acquired immunodeficiency syndrome (AIDS). Clin Orthop 240:129–136.PubMedGoogle Scholar
  11. 11.
    Burstein AH, Reilly DT, Martens M (1976) Aging of bone tissue: mechanical properties. J Bone Joint Surg Am 58:82–86.PubMedGoogle Scholar
  12. 12.
    Conrad EU, Gretch DR, Obermeyer KR, Moogk MS, Sayers M, Wilson JJ, Strong DM (1995) Transmission of the hepatitis-C virus by tissue transplantation. J Bone Joint Surg Am 77:214–224.PubMedGoogle Scholar
  13. 13.
    Currey JD, Foreman J, Laketic I, Mitchell J, Pegg DE, Reilly GC (1997) Effects of ionizing radiation on the mechanical properties of human bone. J Orthop Res 15:111–117.PubMedCrossRefGoogle Scholar
  14. 14.
    Davy DT (1999) Biomechanical issues in bone transplantation. Orthop Clin North Am 30:553–563.PubMedCrossRefGoogle Scholar
  15. 15.
    Dickenson RP, Hutton WC, Stott JR (1981) The mechanical properties of bone in osteoporosis. J Bone Joint Surg Br 63B:233–238.Google Scholar
  16. 16.
    Ehrler DM, Vaccaro AR (2000) The use of allograft bone in lumbar spine surgery. Clin Orthop 371:38–45.PubMedCrossRefGoogle Scholar
  17. 17.
    Einhorn TA (2003) The structural properties of normal and osteoporotic bone. Instr Course Lect 52: 533–539.PubMedGoogle Scholar
  18. 18.
    Fernyhough JC, Schimandle JJ, Weigel MC, Edwards CC, Levine AM (1992) Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine 17:1474–1480.PubMedCrossRefGoogle Scholar
  19. 19.
    Fideler BM, Vangsness CT Jr, Lu B, Orlando C, Moore T (1995) Gamma irradiation: effects on biomechanical properties of human bone-patellar tendon-bone allografts. Am J Sports Med 23:643–646.PubMedGoogle Scholar
  20. 20.
    Fideler BM, Vangsness CT Jr, Moore T, Li Z, Rasheed S (1994) Effects of gamma irradiation on the human immunodeficiency virus. A study in frozen human bone-patellar ligament-bone grafts obtained from infected cadavera. J Bone Joint Surg Am 76:1032–1035.PubMedGoogle Scholar
  21. 21.
    Glazer PA, Colliou O, Lotz JC, Bradford DS (1996) Biomechanical analysis of lumbosacral fixation. Spine 21:1211–1222.PubMedCrossRefGoogle Scholar
  22. 22.
    Goldberg VM (2000) Selection of bone grafts for revision total hip arthroplasty. Clin Orthop 381:68–76.PubMedCrossRefGoogle Scholar
  23. 23.
    Hamer AJ, Strachan JR, Black MM, Ibbotson CJ, Stockley I, Elson RA (1996) Biochemical properties of cortical allograft bone using a new method of bone strength measurement. A comparison of fresh, fresh-frozen and irradiated bone. J Bone Joint Surg Br 78: 363–368.PubMedGoogle Scholar
  24. 24.
    Hirn M, Laitinen M, Pirkkalainen S, Vuento R (2004) Cefuroxime, rifampicin and pulse lavage in decontamination of allograft bone. J Hosp Infect 56:198–201.PubMedCrossRefGoogle Scholar
  25. 25.
    Jensen TB, Overgaard S, Lind M, Rahbek O, Bunger C, Soballe K (2002) Osteogenic protein 1 device increases bone formation and bone graft resorption around cementless implants. Acta Orthop Scand 73:31–39.PubMedCrossRefGoogle Scholar
  26. 26.
    Journeaux SF, Johnson N, Bryce SL, Friedman SJ, Sommerville SM, Morgan DA (1999) Bacterial contamination rates during bone allograft retrieval J Arthroplasty 14:677–681.PubMedCrossRefGoogle Scholar
  27. 27.
    Kainer MA, Linden JV, Whaley DN, Holmes HT, Jarvis WR, Jernigan DB, Archibald LK (2004) Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med 350:2564–2571.PubMedCrossRefGoogle Scholar
  28. 28.
    Kang JS, Kim NH (1995) The biomechanical properties of deep freezing and freeze drying bones and their biomechanical changes after in vivo allograft. Yonsei Med J 36:332–335.PubMedGoogle Scholar
  29. 29.
    Komiya K, Nasuno S, Uchiyama K, Takahira N, Kobayashi N, Minehara H, Watanabe S, Itoman M (2003) Status of bone allografting in japan—nation-wide survey of bone grafting performed from 1995 through 1999. Cell Tissue Bank 4:217–220.PubMedCrossRefGoogle Scholar
  30. 30.
    Kreibich DN, Scott IR, Wells JM, Saleh M (1994) Donor site morbidity at the iliac crest: comparison of percutaneous and open methods. J Bone Joint Surg Br 76:847–848.PubMedGoogle Scholar
  31. 31.
    Kummer FJ, Chen D, Spivak JM (1998) Optimal selection and preparation of fresh frozen corticocancellous allografts for cervical interbody spinal fusion. Spine 23:2295–2298.PubMedCrossRefGoogle Scholar
  32. 32.
    Li CM, Ho YR, Liu YC (2001) Transmission of human immunodeficiency virus through bone transplantation: a case report. J Formos Med Assoc 100:350–351.PubMedGoogle Scholar
  33. 33.
    Lietman SA, Tomford WW, Gebhardt MC, Springfield DS, Mankin HJ (2000) Complications of irradiated allografts in orthopaedic tumor surgery. Clin Orthop 375:214–217.PubMedCrossRefGoogle Scholar
  34. 34.
    Lill CA, Hesseln J, Schlegel U, Eckhardt C, Goldhahn J, Schneider E (2003) Biomechanical evaluation of healing in a non-critical defect in a large animal model of osteoporosis. J Orthop Res 21:836–842.PubMedCrossRefGoogle Scholar
  35. 35.
    Lim EV, Lavadia WT, Roberts JM (1996) Superior gluteal artery injury during iliac bone grafting for spinal fusion. A case report and literature review. Spine 21:2376–2378.PubMedCrossRefGoogle Scholar
  36. 36.
    Lobo Gajiwala A (2003) Tissue banking in India: gamma-irradiated allografts. Cell Tissue Bank 4:203–211.PubMedCrossRefGoogle Scholar
  37. 37.
    Lohmann CH, Andreacchio D, Koster G, Carnes DL Jr, Cochran DL, Dean DD, Boyan BD, Schwartz Z (2001) Tissue response and osteoinduction of human bone grafts in vivo Arch Orthop Trauma Surg 121:583–590.PubMedCrossRefGoogle Scholar
  38. 38.
    Malinin TI, Buck BE, Temple HT, Martinez OV, Fox WP (2003) Incidence of clostridial contamination in donors’ musculoskeletal tissue. J Bone Joint Surg Br 85:1051–1054.PubMedCrossRefGoogle Scholar
  39. 39.
    McCalden RW, McGeough JA, Barker MB, Court-Brown CM (1993) Age-related changes in the tensile properties of cortical bone. The relative importance of changes in porosity, mineralization, and microstructure. J Bone Joint Surg Am 75:1193–1205.PubMedGoogle Scholar
  40. 40.
    McGee MA, Findlay DM, Howie DW, Carbone A, Ward P, Stamenkov R, Page TT, Bruce WJ, Wildenauer CI, Toth C (2004) The use of OP-1 in femoral impaction grafting in a sheep model. J Orthop Res 22:1008–1015.PubMedCrossRefGoogle Scholar
  41. 41.
    Nather A, Thambyah A, Goh JC (2004) Biomechanical strength of deep-frozen versus lyophilized large cortical allografts. Clin Biomech 19:526–533.CrossRefGoogle Scholar
  42. 42.
    Navas J, Soto C (2003) The Colombian experience in tissue banking: the bone and tissue bank of the Cosmos and Damian Foundation, Bogota. Cell Tissue Bank 4:157–161.PubMedCrossRefGoogle Scholar
  43. 43.
    Palmer SH, Gibbons CL, Athanasou NA (1999) The pathology of bone allograft. J Bone Joint Surg Br 81:333–335.PubMedCrossRefGoogle Scholar
  44. 44.
    Pelker RR, Friedlaender GE (1987) Biomechanical aspects of bone autografts and allografts. Orthop Clin North Am 18:235–239.PubMedGoogle Scholar
  45. 45.
    Rasmussen TJ, Feder SM, Butler DL, Noyes FR (1994) The effects of 4 Mrad of gamma irradiation on the initial mechanical properties of bone-patellar tendonbone grafts. Arthroscopy 10:188–197.PubMedCrossRefGoogle Scholar
  46. 46.
    Reilly DT, Burstein AH (1974) The mechanical properties of cortical bone. J Bone Joint Surg Am 56:1001–1022.PubMedGoogle Scholar
  47. 47.
    Roder W, Muller H, Muller WE, Merz H (1992) HIV infection in human bone. J Bone Joint Surg Br 74:179–180.PubMedGoogle Scholar
  48. 48.
    Salzman NP, Psallidopoulos M, Prewett AB, O’Leary R (1993) Detection of HIV in bone allografts prepared from AIDS autopsy tissue. Clin Orthop Relat Res 292: 384–390.PubMedGoogle Scholar
  49. 49.
    Sanzen L, Carlsson A (1997) Transmission of human T-cell lymphotrophic virus type 1 by a deep-frozen bone allograft. Acta Orthop Scand 68:72–74.PubMedGoogle Scholar
  50. 50.
    Schwartz Z, Somers A, Mellonig JT, Carnes DL Jr, Dean DD, Cochran DL, Boyan BD (1998) Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation is dependent on donor age but not gender. J Periodontol 69:470–478.PubMedGoogle Scholar
  51. 51.
    Siddiqui SA, Lipton JF, Vigorita VJ, Evangelista J, Bryk E (2004) Bone biopsy as a screening technique for bone bank allograft donation. Am J Orthop 33: 123–126.PubMedGoogle Scholar
  52. 52.
    Siff TE, Kamaric E, Noble PC, Esses SI (1999) Femoral ring versus fibular strut allografts in anterior lumbar interbody arthrodesis. A biomechanical analysis. Spine 24:659–665.PubMedCrossRefGoogle Scholar
  53. 53.
    Simonds RJ, Holmberg SD, Hurwitz RL, Coleman TR, Bottenfield S, Conley LJ, Kohlenberg SH, Castro KG, Dahan BA, Schable CA, et al (1992) Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 326:726–732.PubMedCrossRefGoogle Scholar
  54. 54.
    Simonian PT, Conrad EU, Chapman JR, Harrington RM, Chansky HA (1994) Effect of sterilization and storage treatments on screw pullout strength in human allograft bone Clin Orthop 302:290–296.PubMedGoogle Scholar
  55. 55.
    Smith CB, Smith DA (1976) Relations between age, mineral density and mechanical properties of human femoral compacta. Acta Orthop Scand 47: 496–502.PubMedGoogle Scholar
  56. 56.
    Soballe K, Jensen TB, Mouzin O, Kidder L, Bechtold JE (2004) Differential effect of a bone morphogenetic protein-7 (OP-1) on primary and revision loaded, stable implants with allograft. J Biomed Mater Res 71A:569–576.CrossRefGoogle Scholar
  57. 57.
    Stevenson S (1999) Biology of bone grafts. Orthop Clin North Am 30:543–552.PubMedCrossRefGoogle Scholar
  58. 58.
    Sugihara S, van Ginkel AD, Jiya TU, van Royen BJ, van Diest PJ, Wuisman PI (1999) Histopathology of retrieved allografts of the femoral head. J Bone Joint Surg Br 81:336–341.PubMedCrossRefGoogle Scholar
  59. 59.
    Summers BN, Eisenstein SM (1989) Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br 71:677–680.PubMedGoogle Scholar
  60. 60.
    Thoren K, Aspenberg P (1995) Ethylene oxide sterilization impairs allograft incorporation in a conduction chamber. Clin Orthop 114:259–264.Google Scholar
  61. 61.
    Thoren K, Aspenberg P, Thorngren KG (1995) Lipid extracted bank bone. Bone conductive and mechanical properties. Clin Orthop 311:232–246.PubMedGoogle Scholar
  62. 62.
    Tomford WW, Mankin HJ (1999) Bone banking. Update on methods and materials. Orthop Clin North Am 30:565–570.PubMedCrossRefGoogle Scholar
  63. 63.
    Tomford WW, Mankin HJ, Friedlaender GE, Doppelt SH, Gebhardt MC (1987) Methods of banking bone and cartilage for allograft transplantation. Orthop Clin North Am 18:241–247.PubMedGoogle Scholar
  64. 64.
    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 72:1137–143.PubMedGoogle Scholar
  65. 65.
    Vehmeyer S, Wolkenfelt J, Deijkers R, Petit P, Brand R, Bloem R (2002) Bacterial contamination in postmortem bone donors. Acta Orthop Scand 73:678–683.PubMedCrossRefGoogle Scholar
  66. 66.
    Wittenberg RH, Moeller J, Shea M, White AA 3rd, Hayes WC (1990) Compressive strength of autologous and allogenous bone grafts for thoracolumbar and cervical spine fusion. Spine 15:1073–1078.PubMedCrossRefGoogle Scholar
  67. 67.
    Woll JE, Kasprisin D (2001) Standards for Tissue Banking. McLean, Virginia: American Association of Tissue Banks.Google Scholar
  68. 68.
    Zhang Y, Homsi D, Gates K, Oakes K, Sutherland V, Wolfinbarger L Jr (1994) A comprehensive study of physical parameters, biomechanical properties, and statistical correlations of iliac crest bone wedges used in spinal fusion surgery. IV. Effect of gamma irradiation on mechanical and material properties. Spine 19:304–308.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2007

Authors and Affiliations

  • Calin S. Moucha
    • 1
  • Regis L. Renard
    • 2
  • Ankur Gandhi
    • 2
  • Sheldon S. Lin
    • 3
  • Rocky S. Tuan
    • 4
  1. 1.Division of Adult Joint Replacement Department of Orthopedics New Jersey Medical SchoolUniversity of Medicine and Dentistry of New JerseyNewarkUSA
  2. 2.Department of Orthopedics New Jersey Medicine SchoolUniversity of Medicine and Dentistry of New JerseyNewarkUSA
  3. 3.Foot and Ankle Division Department of Orthopedics New Jersey Medical SchoolUniversity of Medicine and Dentistry of New JerseyNewarkUSA
  4. 4.Cartilage Biology and Orthopedics Branch National Institute of Arthritis and Musculoskeletal and Skin DiseasesNational Institutes of HealthBethesdaUSA

Personalised recommendations