Musculoskeletal tissue banking in Singapore: 15 years of experience (1988-2003)

Journal of Orthopaedic Surgery, Dec 2004 by Nather, A

Musculoskeletal transplantation

Up to 30 June 2003, 854 bone and soft-tissue transplantations have been performed using soft-tissue allografts procured and processed by NUH Tissue Bank (Table 3). Of the 854, 184 were performed for spinal fusions, 123 for hip surgery, 75 for malignant bone lesions and 88 for bone trauma. 238 patients underwent soft-tissue reconstructions, the majority of which (183) were arthroscopic anterior cruciate ligament reconstruction using the patella-ligamentum patella-tibial tuberosity complex. Of the 854 musculoskeletal transplantations, 450 were performed in NUH, 127 in Tan Tock Seng Hospital, 101 in Singapore General Hospital, 13 in Alexandra Hospital, 9 in Kandang Kerbau Women's and Children's Hospital, 8 in Changi General Hospital, 2 in the National Cancer Centre, 2 in the National Eye Centre and 142 in private hospitals. Over the past 4 years, the number of transplantations performed annually in Singapore has increased to about 100 to 120 transplantations per year.

Complications

Complications were encountered in 19 (2.2%) of the 854 musculoskeletal transplantations performed. These included 9 (6.8%) of the 132 cases undergoing posterolateral spinal fusion, of which 2 had deep infections, 2 had superficial infections, and 5 had pseudoarthroses with implant failure; all these 9 complications were treated successfully, of which the 2 deep infections were salvaged using radical debridement, removal of allografts, and aggressive antibiotic therapy. Other complications included one case that have persistent serous discharge from the thoracic wound of an anterior spinal reconstruction using a lyophilised femoral ring allograft for a burst fracture of the first lumbar vertebra; the sterile discharge settled after 2 weeks. Six (10.5%) complications were encountered in 57 cases undergoing massive bone reconstruction for limb-salvage surgery for malignancy, of which 2 had non-salvageable deep infections and underwent above-knee amputation and 4 had superficial infections and were successfully treated. Other complications included one case of deep infection of a fibula allograft used to augment a short traumatic below-knee stump which could not be saved and resulted in above-knee amputation, one case of implant failure in an elderly woman with delayed union of the humerus treated with plating and onlay fibula allograft, and one case of methicillin-resistant Staphylococcus aureus superficial infection in a patient with delayed union of the femur treated with autografts supplemented by onlay femoral cortical allograft.

DISCUSSION

The outcome of allograft transplantation depends on several factors such as quality control of tissue grafts processed by the tissue bank, the surgeon's understanding of the biological and biomechanical behaviour of allografts, proper selection of indications for the use of allografts, the choice of the most appropriate type of allograft for each indication, and the use of antibiotic prophylaxis to prevent infection.