The use of irradiated allograft in a paediatric population: an Indian experience
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The use of irradiated allograft in a paediatric population: an Indian experience A. Johari Æ V. Shingade Æ A. Lobo Gajiwala Æ V. Shah Æ C. D’ Lima
Received: 8 August 2005 / Accepted: 7 March 2006 / Published online: 28 June 2006
Ó Springer Science+Business Media B.V. 2006 Abstract Lyophilised, irradiated bone allografts available for the first time in the country from the Tata Memorial Hospital Tissue Bank were used in 30 paediatric patients from January 2001 to August 2004. They included 20 patients of scoliosis of various origin and ten with assorted orthopaedic conditions including one congenital kyphosis, two Pott’s spine, one Perthes disease, one developmental dysplasia of the hip (DDH), one infective non-union, one fibrous dysplasia and three with bone defects either due to trauma, a cyst or removal of hardware. Morsellised allograft was used in 28 patients. In those cases of scoliosis in which ribs were resected out during costectomy, the morsellised allograft was mixed with morsellised rib autograft. Non-morsellised femoral head grafts were used in two patients, one a case of varus open derotation osteotomy in Perthes disease and the other an acetabuloplasty in DDH. Patients
A. Johari Æ V. Shingade Æ V. Shah Children Orthopaedic Centre, Boby Apartment, Lady Jamshedji Road, Mahim West, Mumbai, India A. L. Gajiwala Æ C. D’ Lima Tissue Bank, Tata Memorial Hospital, Parel, Mumbai, India V. Shingade (&) 135, Banerjee Lay out, Post Parvatinagar, Nagpur, Maharashtra, India440027 e-mail: [email protected]
were followed at intervals of 8–12 weeks and radiological evaluation was done periodically. The follow up period ranged from 1 to 4 years post surgery. All patients with scoliosis showed excellent union at the grafting site with non-progression of curve and no signs of loosening at implant site. The two patients, in whom non-morsellised femoral head grafts were used, both showed incorporation of the graft with good fusion within a 4 month period. None of the patient had infection, non-union, pseudoarthrosis, fracture at the graft site, or any other complication. Keywords Lyophilised irradiated allograft Æ Orthopaedic deformities Æ Paediatric population
Introduction In India, the paediatric population forms a major group among patients presenting with orthopaedic manifestations. Deformity correction surgeries in these children usually involve fusion of bones in addition to correction. Scoliosis is one of the conditions for which fusion is required, quite often in addition to the correction of a deformity, and this usually requires a large amount of bone graft. Although autograft remains the gold standard to achieve union, getting the autograft in sufficient quantity, in the paediatric age group is usually difficult. It is also associated with donor site morbidity, requiring an additional incision along the iliac crest,
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chances of apophyseal damage, additional surgical time and blood loss (Cockin 1971; Kreibich et al. 1994; Summers and Einstein 1989). To obviate these risks, allografts have
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