Update on the supply and use of allografts in locomotor system pathologies in France.

Allografts are increasingly used in orthopedics. The main aim of the present study was to map the use of locomotor system allografts in France between 2012 and 2016. The study hypothesis was that there are great differences in the distribution and activity of tissue banks and graft preservation procedure quality, failing to meet national requirements. MATERIAL AND METHODS: Data from activity reports of the French Biomedicine Agency (ABM) were collected for the period 2012-2016. Existing viral inactivation procedures were described. Preliminary results from a study of allograft requirements by the French Society of Arthroscopy (SFA) were reported. RESULTS: Nineteen tissue banks were located. Four dealt exclusively with cryopreserved tissue, 3 exclusively with virus-inactivated bone, and 12 with both. Distribution analysis found wide disparities in geographic location and in type of activity. Viral inactivation is presently implemented only for femoral heads derived from hip replacement. Stocks of long bones, femoral heads and ligaments/tendons increased constantly over the study period, by 8.3%, 50.8% and 316.2% respectively. The SFA questionnaire confirmed a serious shortage of tissues, necessitating importation of allografts. DISCUSSION: Each tissue bank had its own specificities and specialization. They should probably be coalesced, so as to centralize both supply and demand and improve nationwide response to requirements. Locomotor system tissue harvesting also needs to be expanded to meet increasing demand.

Endemic impact of human T cell leukemia virus type 1 screening in bone allografts.

Allograft bone is a widely used as a convenient tool for reconstructing massive bone defects in orthopedic surgery. However, allografts are associated with the risk of viral disease transmission. One of the viruses transmitted in this manner is human T-lymphotropic virus type 1 (HTLV-1), which is found worldwide but is unevenly distributed. The southwestern parts of Japan are a highly endemic for HTLV-1. We investigated the HTLV-1 seroprevalence in candidate allograft donors at the regional bone bank in Kagoshima, Japan during its first 5 years of service. Between 2008 and 2012, we collected 282 femoral heads at the Kagoshima regional bone bank from living donors with osteoarthritis of the hip joint. Among the 282 candidate donors, 32 donors (11.3 %) were seropositive for anti-HTLV-1 antibody; notably, this prevalence is higher than that reported for blood donors in this area. Additionally, to determine if HTLV-1 genes are detectable after processing, we examined the bone marrow of the femoral heads from seropositive donors by conducting PCR assays. Our results confirm the existence of viral genes following the heat treatment processing of the femoral heads. Therefore, it is important to inactivate a virus completely by heat-treatment. Together, our findings highlight the importance of HTLV-1 screening at bone banks, particularly in HTLV-1-endemic areas such as southwest Japan.

[Salvaged femoral heads banked for re-use. Excellent bone replacement in revision of prosthetic surgery]. / Gamla lårbenshuvuden får ny användning som bankben. Utmärkt benersättningsmaterial vid protesrevision.

Morsellized and compacted femoral heads salvaged after hip arthroplasty constitute an excellent bone replacement material. Access to this material has substantially improved prognosis following replacement of loosened prostheses, a finding contrary to previous experience with uncompacted bone grafts and for which only hypothetical explanations are available. Although bank bone is a material without manifest value beyond its material properties, it is sometimes referred to as a transplant, a usage that has resulted in its occasional use under the misapprehension that it will promote bone repair, which may cause problems. Otherwise, bank bone is more or less innocuous and is not associated with a greater risk of viral infection transmission than is blood transfusion. The article provides a review of the biological effects to be expected of bank bone implants, how the risk of infection can be avoided, and which indications are appropriate.

Viral inactivation of human bone tissue using supercritical fluid extraction.

A new bone tissue process using supercritical carbon dioxide fluid extraction (SFE) has been evaluated for its ability to inactivate or eliminate viruses. Four viruses, human immunodeficiency virus type 1 (HIV-1), Sindbis virus, polio Sabin type I virus, and pseudorabies virus (PRV), were exposed to four different processing steps. In addition to supercritical CO2, hydrogen peroxide, sodium hydroxide, and ethanol treatments were evaluated. The mean cumulated reduction factors (log10) for the four viruses exposed to these four steps were > 14.2 for HIV-1, > 18.2 for Sindbis virus, > 24.4 for poliovirus, and > 17.6 for PRV. The mean reduction factors obtained by the supercritical fluid extraction alone were > 4.0, > 4.3, > 6.6, and > 4.0, respectively. These results demonstrate that the SFE process is effective in inactivating viruses on human femoral heads, and provides a level of inactivation similar to that obtained by traditional cleaning methods. It is proposed that CO2 SFE be incorporated as a routine step in the processing of bone allografts for transplantation either to replace or supplement existing procedures.

[Inactivation of HIV-1 in human femur heads using a heat disinfection system (Lobator SD-1)]. / Untersuchungen zur Inaktivierung von HIV-1 in humanen Femurköpfen durch Verwendung eines thermischen Desinfektionssystems (Lobator SD-1).

The use of allogenic bone transplants in surgery has been greatly diminished owing to the risk of transmitting infectious diseases. This risk can be reduced by the use of a thermal disinfection system (Lobator SD-1). This is achieved by increasing the temperature to 80 degrees C, inactivating a number of bacterial and viral agents. In this study the decay of HIV at high temperature in the Lobator SD-1 was researched. In the center of human femoral heads 100 microliters of a highly concentrated suspension of free and cell-bound HIV (10(10)) was exposed to the thermal process at intervals of 5, 10, 20, 30, 40, 50 and 62 min. For the recultivation HUT-78 cells were used through titration of the virus suspension in ten-fold dilutions over ten dilution steps and incubation up to a maximum of 21 days. Evidence of the virus was checked through observing giant cell formations and quantitative determination of p24 antigen using an Elisa test. Linear virus inactivation was found based upon the time the virus was exposed to heat. After a treatment of 40 min in the disinfection system, total virus inactivation was achieved. The normal disinfection process time using Lobator SD-1 is 92 min. A temperature of 80 degrees C is reached after approximately 45 min. The results prove that this system totally inactivates HIV in human femoral heads.

[Optimal conditions of gamma type irradiation for inactivating HIV in bone fragments. Consequences in biomechanical resistance of the bone tissue]. / Conditions optimales d'irradiation de type gamma en vue de L'inactivation du VIH présent dans les fragamants osseux. Conséquences sur la résistance biomécanique du tissue osseux.

In order to determine bone-dependent penetration differences, we conducted a dosimetric study of gamma radiation using 2.5 mega rads on cancellous bone fragments at 4 degrees C and below 0 degrees with or without a surrounding solution. Variations in dose received inside and outside the femoral head were independent of radiation temperature but varied with the presence or absence of a surrounding solution. We then verified the gamma radiation effect on femoral heads infected with HIV: as free virus and in chronically infected cells. we evaluated infectious capacity after radiation by visualizing syncitia formation and by reverse transcriptase assay. The results for the controls were negative for free virus and positive for chronically infected cells. The virus was still after radiation. At the same time, we studied the effect of gamma radiation at different doses (0, 2.5, 5 mega rads) on biomechanical characteristics of bone, particularly crush resistance. Statistical analysis of the compression curves showed that resistance declined after high radiation at 5 mega rads, but the mean values obtained were within the range of values commonly accepted for human bone crush resistance.