Abstract
Introduction: Filling of bone defects is a significant challenge in Orthopaedic Surgery. Human fresh-frozen allograft is still the most effective bone graft substitution material («gold standard»), guaranteeing all essential biological and physiochemical demands (osteogenic, osteoinductive, and osteoconductive) when the necessary amount of autologous bone is not available. Using donor screening recommendations, more than 50 % of potential donors have to be excluded. With increasing incidence for revision hip surgery and especially acetabular reconstructions, a hospital associated bone bank has difficulties meeting demand. The aim of this study is to evaluate the balance and resource utilisation of a hospital associated bone bank for fresh-frozen allografts and the correlation to commercial alternatives regarding cost effectiveness.
Method: For evaluation of resource utilisation and cost effectiveness of a hospital associated bone bank, all donation processes and the details of allograft use were analysed and summarized within a period of 30 months. Given the increasing disproportion of demand and availability, the reasons for exclusion, especially for exclusion during the preservation period, were carefully scrutinized. The costs of installation and maintenance of the bone bank, as well as all costs in the screening process were balanced to calculate the «per head»-price. The results were compared to commercial alternatives.
Results: Within the period of evaluation 632 femoral heads were available for donation. Through the screening process 359 femoral heads (56.8%) met at least one criterion for exclusion. At the end of the observation period of six months and after HIV retesting, 246 allografts met all criteria for use. The mean period between inclusion in the bone bank and release was 10.9 5.0 months (range 6.0–30.8).
50.8% of released allografts (125 heads) were used in revision arthroplasty. In spine surgery 83 allografts (33.7%) were implanted in spinal fusions and for cage filling during vertebral body replacement. Thirty-two grafts (13.0%) were used in miscellaneous surgeries with minor bone demand.
The costs per donation were 92, with personnel costs the price per head was 140. The price range for commercial alternatives starts at 100 for 1 cm.
Conclusion: A hospital associated bone bank for fresh-frozen allografts is still an effective and cost effective method to maintain material for bone defect filling. To meet demand, information and communication to donors has to be increased to get the HIV-retests. Additionally, division of donations into smaller portions helps to decrease waste in surgeries where less bone is required.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
