Dr. Sabarathinam. R. Subramaniya
In a significant stride towards enhancing orthopaedic care, the All India Institute of Medical Sciences (AIIMS) in Jammu is poised to establish a groundbreaking Bone Bank. This cutting-edge facility will serve as a hub for collecting, processing, storing, and distributing bone grafts, facilitating transformative reconstructive surgeries for patients in need. With meticulous attention to safety and sterile protocols, AIIMS Jammu’s Bone Bank is set to revolutioniseorthopaedic treatments and restore hope for individuals seeking improved mobility and quality of life.
Understanding the Significance of a Bone Bank in Orthopedics:
A bone bank, also known as a musculoskeletal allograft bank, plays a pivotal role in orthopaedics by providing a reliable source of bone grafts for various surgical procedures. These grafts are essential when a patient’s bone (autograft) is inadequate or unsuitable for transplantation. Bone banks bridge this gap by offering safe and sterile bone grafts, ensuring the success and longevity of reconstructive surgeries.
The Process of Bone Donation and Preservation:
The bone donation and preservation journey begins when individuals express their desire to donate their bones after death or their families consent to organ and tissue donation. Trained medical professionals carefully retrieve the bone tissues from deceased individuals, adhering to strict sterile conditions. The donated bones are then transported to AIIMS Jammu’s Bone Bank.
At the bone bank, meticulous procedures are implemented to ensure safety and quality. Thorough cleaning and sterilisation processes are conducted to eliminate potential contaminants and infectious agents. Preservation techniques, such as deep freezing, are employed to maintain the viability and structural integrity of the bone grafts over an extended period.
Contrasting Autografts and Allografts in Surgical Procedures:
Autografts, involving the use of a patient’s own bone, are considered the gold standard in orthopaedic surgeries due to their high success rate and compatibility. However, harvesting the patient’s bone requires an additional surgical procedure, which can lead to pain, scarring, and potential complications at the donor site. Autografts may not be enough if there is a massive bone loss that has to be addressed.
In contrast, allografts obtained from a bone bank offer several advantages. They provide a readily available and sterile source of bone grafts, eliminating the need to harvest the patient’s bone. This reduces surgical time and potential complications at the donor site. However, allografts may have a slightly lower incorporation rate compared to autografts
Ensuring Safety and Quality in Bone Bank:
Safety and quality are of paramount importance in bone banking. AIIMS Jammu’s Bone Bank adheres to stringent regulations and guidelines set by regulatory bodies such as the National Organ and Tissue Transplant Organization (NOTTO) and international organisations (WHO). Each donated graft undergoes meticulous screening for infectious diseases, including HIV, hepatitis, and other potential pathogens. Proper documentation and traceability are maintained to ensure quality control.
Surgical Procedures Utilizing Bone Allografts:
Bone grafts from AIIMS Jammu’s Bone Bank find extensive use in various surgical procedures. Joint replacement surgeries(primary and revision), such as hip or knee replacements, benefit from grafts that fill defects or reinforce weakened areas around the prosthetic joint, improving stability and long-term success. Spinal fusion surgeries, addressing certain spinal conditions, also utilise bone grafts for optimal results. Moreover, bone grafts are crucial in nonunions, complex trauma cases with massive bone loss, and reconstructive surgeries for bone tumours.
Storage Duration and Viability of Bone Grafts:
Generally, with proper techniques, bone grafts can be stored for several years, ranging from five to seven years, while maintaining their viability and structural integrity. This extended storage duration ensures ample grafts for timely orthopaedic interventions.
Potential Risks and Mitigation Measures:
While bone grafts from a bone bank are generally safe, it’s essential to acknowledge the potential risks associated with any medical procedure. In rare cases, grafts may transmit infections or trigger immune responses. However, the rigorous screening and processing protocols employed by AIIMS Jammu’s Bone Bank will significantly minimise these risks. Patients are advised to engage in thorough discussions with their surgeons to understand the potential benefits and risks associated with bone grafts.
Matching Donated Bone Grafts to Recipients:
Matching a donated bone graft to a recipient involves carefully considering several factors. Surgeons assess the size and shape of the graft to ensure compatibility with the recipient’s anatomical needs. The specific surgical procedure, the defect or area requiring reconstruction, and the patient’s unique anatomy are considered. AIIMS Jammu’s Bone Bank evaluates the recipient’s medical history, including allergies and potential risks, to ensure the suitability of the graft.
Ensuring Safety and Quality for Patients:
Patients can ensure the safety and quality of their bone grafts by seeking treatment from reputable healthcare institutions like AIIMS Jammu. Experienced surgeons well-versed in performing these procedures and adherence to proper protocols for graft selection, screening, and surgical techniques are essential. Patients are encouraged to inquire about the bone grafts’ source, processing, and sterilisation procedures to gain confidence in their safety and quality.
Precautions and Aftercare for Patients Receiving Bone Grafts:
Following the surgeon’s instructions carefully is vital. This may include adhering to weight-bearing or physical activity limitations for a specific period to allow proper integration and healing of the graft. Patients may also require a prescribed rehabilitation program involving physical therapy or exercises to regain strength and mobility. Regular follow-up appointments are necessary to monitor bone healing progress and address any concerns or complications that may arise.
Graft Integration:
Bone graft integration refers to the graft fusing with the patient’s bone, establishing a stable connection. After the graft is placed, bone-forming cells from the patient’s body infiltrate the graft and deposit new bone tissue. The graft undergoes remodelling, gradually incorporating with the surrounding bone. The duration for full graft incorporation varies depending on factors such as the patient’s age, overall health, and the specific surgical procedure. Generally, the process can take several months to over a year to achieve optimal stability and support.
AIIMS Jammu’s Bone Bank is a groundbreaking initiative that will transform orthopaedic treatments in the region. With its state-of-the-art infrastructure, rigorous safety measures, and a dedicated team of medical professionals, Bone Bank is poised to revolutionise patient care. Providing safe and sterile bone grafts will empower surgeons to achieve better outcomes in reconstructive surgeries, restoring hope and mobility to countless needy individuals. The establishment of AIIMS Jammu’s Bone Bank marks a significant leap forward, promising a brighter future for orthopaedic patients in the region.
(The author is Assistant Professor, Dept of Orthopaedics, AIIMS, Jammu.).