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Intra-operative washing of morcellised bone allograft with pulse lavage: how effective is it in reducing blood and
T Ibrahim1, A Qureshi, T A McQuillan
1Department of Orthopaedic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. ti11@le.ac.uk
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.
Insights
Pulse lavage effectively removes protein, fat, and DNA from bone allografts, significantly reducing the risk of transmitting blood-borne diseases like variant Creutzfeld-Jakob Disease. This simple washing method is recommended for routine bone allograft preparation.
Area of Science:
- Biomedical Engineering
- Orthopedic Surgery
- Infectious Disease Control
Background:
- Unprocessed bone allografts pose a risk for transmitting blood-borne diseases.
- A theoretical risk of variant Creutzfeld-Jakob Disease (vCJD) transmission exists due to probable blood-borne spread.
- Standard operating theatre pulse lavage is a potential method for decontaminating bone allografts.
Purpose of the Study:
- To evaluate the effectiveness of pulse lavage in removing protein, fat, and double-stranded Deoxyribonucleic acid (dsDNA) from morcellised bone allograft.
- To assess the potential of pulse lavage to mitigate the risk of prion and other blood-borne disease transmission.
- To determine if pulse lavage enhances the safety of bone allograft preparation.
Main Methods:
- Twelve donated femoral heads were processed into bone chips.
- One set of bone chips was washed using standard operating theatre pulse lavage; the other served as a control.
- A validated multistep washing protocol was employed to quantify protein, fat, and dsDNA levels in both washed and unwashed samples.
Main Results:
- Pulse lavage removed a significant amount of protein (70.5%), fat (95.2%), and DNA (68.4%) from the morcellised bone allograft.
- The washing process demonstrated a wide range of effectiveness for each component, indicating variability but consistent removal.
- Significant reduction in biological contaminants suggests improved allograft safety.
Conclusions:
- Intra-operative pulse lavage is effective in removing protein, fat, and DNA from morcellised bone allograft.
- This decontamination process may reduce the theoretical risk of prion and other blood-borne disease transmission.
- Pulse lavage is recommended as a routine step in bone allograft preparation, potentially improving safety and mechanical characteristics.
