Bone bank
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Here is a comprehensive overview of Bone Banking based on authoritative orthopaedic and laboratory medicine textbooks.
Bone Bank
A bone bank is a facility that collects, processes, stores, and distributes bone (and related musculoskeletal tissue) allografts for use in surgical procedures.
History
Bone banking began several decades ago when physicians first stored surgical discard bone — mostly femoral heads from joint replacement surgery — for future use in spinal fusions and other orthopaedic procedures. Early practices involved simple, unmonitored freezer storage with no testing, tracking, or donor consent. Today, these practices have been largely eliminated through the use of registered, accredited tissue banks with strict regulatory oversight.
— Henry's Clinical Diagnosis and Management by Laboratory Methods
Sources of Bone
| Source | Description |
|---|---|
| Surgical discard (autologous discard) | Femoral heads and other bone removed during primary procedures (e.g., arthroplasty) |
| Deceased donors | Screened and tested donors; most common source for large structural allografts |
| Living donors | Still used for certain bone types; require full informed consent and screening |
Processing
Surgical discard and deceased donor bone are processed similarly:
- Cleaning — Extraneous tissue, blood, and marrow are removed by high-pressure pulse washing
- Antibiotic soak — Tissue is soaked in antibiotic-containing solutions
- Bacteriologic culture — Performed at collection, during processing, and before freezing
- Lipid removal — Ethanol soaks may be used (especially for demineralized, lyophilized bone), which also reduces infectivity
- Sterilization — Low-dose irradiation is most common; ethylene oxide has been largely abandoned due to adverse reactions in recipients
- Preservation — Freezing (−60°C to −150°C) or freeze-drying (lyophilization)
Storage
- Viable tissue (cartilage, femoral head, tendon, whole bone): frozen at −60°C to −150°C, or cryopreserved in vapor/liquid nitrogen (−150°C to −196°C)
- Freeze-dried (lyophilized) bone: can be stored for 5 years or potentially indefinitely
- Expiration: generally 5 years post-collection, though some products may last longer
Biological Properties
- Bone allografts serve primarily as mechanical support and an osteoconductive scaffold for the host's bone-forming cells
- Osteoinductive function depends on growth factor glycoproteins (BMPs) retained in the graft
- Antigenicity is low — blood and marrow are removed during processing; ABO/HLA matching is generally not required
- Exception: large osteoarticular grafts (e.g., whole bone–patellar tendon) may contain residual RBCs; Rh-compatible tissue is recommended for Rh-negative females of childbearing age
Clinical Uses
Bone allograft from a bone bank is used for:
- Spinal fusion surgery
- Revision joint arthroplasty (failed prosthetic joints)
- Packing of benign bone cysts
- Maxillofacial and periodontal reconstruction
- Alveolar bone restoration
- Tumour resection reconstruction (e.g., osteosarcoma)
- Tibial plateau fractures and other void-filling applications
— Henry's Clinical Diagnosis and Management by Laboratory Methods; Rockwood and Green's Fractures in Adults
Autograft vs. Allograft (Bank Bone)
| Feature | Autograft | Allograft (Bank) |
|---|---|---|
| Incorporation | Faster | Slower |
| Immunogenicity | None | Low |
| Disease transmission | None | Very low (screened) |
| Supply | Limited | Ample |
| Donor site morbidity | Yes (pain, blood loss, longer anaesthesia) | None |
Disease Transmission Risk
A major concern with bone banking is the risk of transmitting infectious agents. Modern screening has dramatically reduced this risk:
- HIV from frozen bone allograft: < 1 per 1,000,000
- No cases of HIV from fresh-frozen bone allograft have been reported since 2001
- Donor screening is the single most important factor in preventing viral transmission
- Allografts are screened for HBsAg, HBcAb, and HCV
- Most sensitive screening method: Nucleic Acid Amplification Testing (NAAT/PCR)
— Miller's Review of Orthopaedics, 9th Edition
Accreditation and Regulation
Modern bone banks operate under strict standards:
- Registered and accredited by bodies such as the American Association of Tissue Banks (AATB)
- Mandatory donor consent, infectious disease testing, processing documentation, and recipient tracking
- Storage conditions are continuously monitored
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