Bone Banking in Community Hospitals

Abstract

It has become apparent that replacement of bone stock is necessary at an increasing rate during revision and reconstructive surgery after failed total joint arthroplasty [4, 5]. This requires the availability of banked bone. Since complex tissue banking is expensive, all large regional and institutional bone banks are limited to tertiary care centers. These institutions cannot supply sufficient banked allograft bone at a national level. On the other hand, patient access to tertiary care centers is limited and transfer of increasing numbers of patients to such centers is not practical. These considerations give a rationale for bone banking and the use of banked allograft bone at the local community hospital level. Although the logistics of bone banking in local community hospitals are different from those of complex banking procedures, the general guidelines that ensure reliable preservation, safety, and availability of banked bone apply in the same manner as established previously for regional and institutional tissue banks [1, 3]. Community bone banking requires safe, simple, and cost-effective methods or preservation. These criteria are best met by deep-freezing. Advantages of deep-frozen allografts (bank bone) over fresh autografts are: unlimited quantity, no donor site morbidity, and maintained osteoconductive function. Their disadvantages are: lack of osteogenic and osteoinductive function, slow healing rate, and potential to sensitize the recipient.