Abstract
Femoral head allograft bone used in complex orthopaedic surgery may transmit infection from donor to recipient. In order to minimise the risk all donors are serologically screened for Hepatitis B and C, HIV, HTLV, and syphilis at the time of donation and again at 6 months post-donation. Culture swabs are taken from the acetabulum and femoral head for 48 hour anaerobic and aerobic culture, and a sample of bone is incubated for 5 days in enrichment broth culture.
We have audited the culture results and screening tests performed in our bone bank from 2000 to 2005 inclusive.
1,528 allografts were received of which we had to discard 52 (3.4%) because of either positive cultures or serology. The vast majority of the positive cultures were due to S. epidermidis (30/43). All cultures were bacteria one might expect to find as normal skin flora. 3 patients had positive hepatitis C serology and 6 were syphilis EIA positive.
In May 2004 we decided in line with National Transfusion Guidelines for blood donation, to exclude donors who had had a blood transfusion since 1980 to mini-mise the risk of transmission of CJD. This and the opening of an Independent Treatment Centre (ITC) in our area drastically limited the number of possible donors to our bone bank. There was a significant reduction in the number of femoral heads received in 2004 and 2005 when compared with years 2000-2003 (p = < 0.00001).
We conclude that negligible numbers of femoral head allografts are lost due to our serological and microbio-logical screening tests. However measures introduced to limit the theoretical transmission of CJD via a bone allograft and the opening of a local ITC have had a huge impact on the number of potential donors available to us. To date the CJD prion has not been isolated from bone, but there have been 3 reported cases of transmission of infection by blood transfusion. We fear that the imminent introduction of a serological test for CJD will limit the number of possible bone donors even further.
Correspondence should be addressed to Mr Carlos Wigderowitz, Senior Lecturer, University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY.
