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Inaccuracy in selection of massive bone allograft using template comparison method.

Laurent Paul1, Pierre-Louis Docquier, Olivier Cartiaux

  • 1Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 53 avenue Mounier, 1200 Bruxelles, Belgium. l.paul@uclouvain.be

Cell and Tissue Banking
|February 7, 2008
PubMed
Summary

Selecting massive bone allografts using current methods is inaccurate. This study found that even with a "trap graft," observers frequently misidentified suitable bone transplants, highlighting the need for improved selection procedures.

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Area of Science:

  • Orthopedics
  • Transplantation Surgery
  • Biomedical Engineering

Background:

  • Massive bone allograft use is rising, yet selection methods remain unchanged.
  • Current gold standard involves radiographic superposition and distance comparison.
  • This method's efficacy for complex grafts like hemipelvis requires evaluation.

Purpose of the Study:

  • To assess the accuracy of the conventional massive bone allograft selection procedure.
  • To evaluate inter-observer agreement in classifying allograft suitability.
  • To identify potential flaws in the current selection process for hemipelvic allografts.

Main Methods:

  • Four observers evaluated nine massive bone allografts for ten simulated recipients.
  • A 'trap graft' (recipient's own bone) was included to test detection.
  • Grafts were classified by adequacy, and observers selected the top three matches.

Main Results:

  • Inter-observer agreement ranged from moderate (kappa=0.47) to substantial (kappa=0.74).
  • The 'trap graft' was incorrectly classified as adequate 10% of the time and selected as a top match 20% of the time.
  • No observer identified the 'trap graft' as the recipient's own bone.

Conclusions:

  • The current radiographic superposition method is inaccurate for selecting hemipelvic bone allografts.
  • Significant limitations exist in distinguishing appropriate allografts from unsuitable ones.
  • Development and testing of novel, more accurate allograft selection methods are urgently needed for tissue banks.