Human Skeletal Allograft Collection — Room for Improvement?

Abstract

Aim: To assess the efficiency of skeletal allograft collection from patients undergoing primary joint arthroplasty at a District General Orthopaedic Unit. Methods: A two cycle audit was performed. Between cycles procedural changes were implemented to improve the efficiency of allograft collection. The discard rate of donated allograft was also assessed during each cycle. Results: Initially 80 patients were identified. Eight (8/80) did not donate allograft due to medical contraindications. Two (2/80) patients underwent intra-operative autologous born grafting. Allograft was not collected from 22 (22/70) suitable patients. As such only 68.6% of suitable bone was collected by the West of Scotland Blood Transfusion Service (WSBTS). Subsequently 100 patients were studied. Twenty-eight (28/100) patients did not donate allograft due to medical contra-indications. Two (2/100) patients underwent intra-operative autologous bone grafting. Eight (8/70) allografts were discarded as a result of logistical problems. As such 88.9% of suitable allograft was collected. Initially 29% of all allograft donated was rejected due to poor patient selection. This subsequently fell to 9.4%. Conclusion: By auditing the collection process a significant improvement (c² = 7.17 df = 1 p = 0.001) in the efficiency of allograft collection was achieved. This was complemented by a significant reduction(c² = 6.09 df= 1 p=0.05) in the proportion of unsuitable allograft donated to the WSBTS.