Lecture 10

Question 1

What is a muscoskeletal graft used for?

Answer 1

= Situations where there is bone LOSS
- Orthopaedics 
o +++ wear 
o Infection
o Joint replacement 
o Osteosarcoma
o Fracture 
o Fusion
o Tendon/ligament repair 

• Maxillo-facial/dentistry
• Other
  o Urology
  o Plastic Surgery

Question 2

Cadaveric muscoskeletal Donation Timeline

Answer 2

o 3-7 months donation to released allograft

• window period NAT 11-34 days
• Quarantine avg. 3months

Question 3

Femoral Head Donation Timeline

Answer 3

o 8-12 months donation to released allograft

- quarantine min 6months

Question 4

What is the living donor program?

Answer 4

• Total hip replacement patients
• Femoral head usually discarded –> can be donated
• approx 800p/yr = 1200 allografts

Question 5

What is the Cadaveric program?

Answer 5

• Donation of long bones and tendons from deceased donors

- 12 p/yr = 500 allografts

Question 6

Cadaveric Tissue Processing

Answer 6

1. Debridement –. removal of extraneous muscle + CT
2. Cutting - into required objects/shapes
3. Packaging - tight & strict, eliminates contamination

Question 7

Femoral Head Processing

Answer 7

• Bioburden Reduction –> Irradiation –> (ANSTO-

- Release for transplant

Question 8

Bone Morphology

Answer 8

70% inorganic (calcium)
30% organic (collage type 1)
- growth factors (cytokines, BMPs)
- Resoption & remodelling (osteoclasts & osteoblasts)

Question 9

Define osteogenesis

Answer 9

Normal bone growth. Requires osteoblasts and osteoprogenitor cells

Question 10

Define osteoconduction

Answer 10

Growth of bone through scaffold

Question 11

Define osteoinduction

Answer 11

• Promotion of bone growth

–> May be due to GFs (BMPs) = active osteoinduction

–> May be due to environmental/morphological factors

Question 12

Muscoskeletal Autografts

- Pros & Cons

Answer 12

• patients own bone
• usually illiac crest

Also fibula, radius, ulna, hamstring tendons, patella tendon etc.

PROS
o Cost effective 
o Osteoconductive
o Osteogenic
o Osteoinductive
o Non-immunogenic

CONS
o Donor site morbidity

Question 13

Muscoskeletal Allograft

- Pros & Cons

Answer 13

• Donated bone
• Many types

PROS
o Osteoconductive

CONS
o Not osteogenic
o Limited osteoinduction

Question 14

Demineralised bone matrix

- Pros & Cons

Answer 14

• Allograft that’s removed the mineral phase

PROS
o Osteoconductive
o Osteoinductive (variable)

CONS
o Not osteogenic
o Expensive

Question 15

Osteosarcoma

Answer 15

• most common type of bone cancer
  –> 6th most common childhood cancer
  = malignant bone tumour
• more common in boys
• occurs during period of growth spurt
• occurs at ends of long bones (knees common)
• requires aggressive treatment

Question 16

What is the process overview look like?

Answer 16

Referral > 
Donor screening >
Retrieval >
Microbial analysis of donated tissue >
Histology of donated tissue >
Radiolological analysis of donated tissue >
Processing and washing of all tissue >
High dose Irradiation >
Release >
Distribution >
Implant

Question 17

Donor screening exclusion criteria

Answer 17

Individual assessment of all donors (Ultra Conservative)

• Heavily regulated by TGA
• Medical & Socials History
• Face to face donor interview (FHD)

Including, but not limited to:

• Past or present malignancy
• Autoimmune disorders
• Travel history
• Hepatitis B & C, HIV, HTLV, Syphilis
• Medication, previous surgery etc

Question 18

Define osteointergration

Answer 18

Ability of graft to integrate into the recipients bone.