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The pathology of bone allograft
S H Palmer1, C L Gibbons, N A Athanasou
1Nuffield Orthopaedic Centre, Oxford, England, UK.
Insights
Histological examination of femoral heads for bone donation revealed occult diseases in 8% of cases. This highlights the need for routine screening to ensure allograft safety and efficacy.
Area of Science:
- Orthopedics
- Pathology
- Tissue Banking
Background:
- Osteoarthritis is a common condition affecting femoral heads.
- Femoral heads are frequently considered for bone allograft donation.
- Screening protocols for bone donation primarily focus on infectious diseases.
Purpose of the Study:
- To determine the prevalence of non-osteoarthritic pathological lesions in femoral heads intended for bone banking.
- To assess the suitability of osteoarthritic femoral heads for bone allograft donation based on histological findings.
Main Methods:
- Histological analysis of 1146 osteoarthritic femoral heads.
- Identification and classification of pathological conditions beyond osteoarthritis.
Main Results:
- 8% (91 out of 1146) of femoral heads exhibited occult pathological conditions.
- Commonly identified diseases included chondrocalcinosis (63 cases), avascular necrosis (13), osteomas (6), and malignant tumors (3).
- Other findings included metabolic bone disease (2 cases) and inflammatory arthritis (4 cases).
Conclusions:
- Occult pathological conditions are prevalent in osteoarthritic femoral heads considered for bone donation.
- Histological examination should be integrated into bone-bank screening protocols.
- This practice is crucial for ensuring the safety and quality of bone allografts.
Abstract:
We analysed the histological findings in 1146 osteoarthritic femoral heads which would have been considered suitable for bone-bank donation to determine whether pathological lesions, other than osteoarthritis, were present. We found that 91 femoral heads (8%) showed evidence of disease. The most common conditions noted were chondrocalcinosis (63 cases), avascular necrosis (13), osteomas (6) and malignant tumours (one case of low-grade chondrosarcoma and two of well-differentiated lymphocytic lymphoma). There were two with metabolic bone disease (Paget's disease and hyperparathyroid bone disease) and four with inflammatory (rheumatoid-like) arthritis. Our findings indicate that occult pathological conditions are common and it is recommended that histological examination of this regularly used source of bone allograft should be included as part of the screening protocol for bone-bank collection.