Introduction: Depleted or insufficient bone stock in primary and subsequent revision surgeries has become challenging problem in osteoreconstructive surgery. Although autologous bone graft remains the gold standard for addressing this problem but limited availability and donor site morbidity are two of its major shortcomings. Allogenic bone grafts serve as an excellent solution for the above shortcomings of autologous graft and synthetic bone substitutes, but allogenic bone graft are inherently susceptible to colonization by small colony variants forms of microorganisms and thus a higher rate of infection has been found to be associated with their use. Hence current study is conducted to assess efficacy of allogenic bone graft with and without antiobiotic impregnation and its effect on infection control and osteointegration.
Material and Methods:In our study a total of 30 patients who required allogenic bone grafting for varied indications The institutional bone bank had bone grafts procured from consenting patients having undergone total hip and knee arthroplasty at the institute and stored them at -760 Celsius for minimum of three months before use. The gamma irradiation was achieved by giving a dose of 25 grays of radiation at an accredited centre. Both the groups were broadly compared in terms of occurrence of infection, healing status of the bone achieved, extent and rate of osteointegration of bone allograft. Postoperative infection was identified by using WHO Giudelines For SSI81, osteointegration was assessed by radiographic signs on plain x-rays as delineated by Sloof et al.
Discussion and Conclusion: Vancomycin impregnated allogenic bone graft appears to be safe and effective filler, without any systemic and local adverse effects, for bone defects secondary to benign osteolytic lesions and relatively fresh fractures with communition and bone loss as graft osteointegration and bone healing does not get adversely affected as well as prophylaxis against infection is also gained by its use. The use of allogenic bone graft in established non unions and delayed unions may require augmentation with osteogenic potentiators to expedite the already sluggish healing process in these cases. This study may serve as a basis for further studies assessing the use of vancomycin impregnated allogenic bone graft as a local antibiotic delivery system in controlled osteoarticular infections.
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