Dr Arun Goel,
Senior Orthopedic Consultant,
Moolchand medcity, Shanti Mukund hospital

Dr Neetan Sachdeva,
Orthopedic Consultant,
Moolchand Medcity


Every kid is given a piggy bank to store loose coins and rupees for later use. It would be wonderful if hospitals treat bones the same way and store them for a rich supply of bone mass whenever required .

Bone banks are necessary for providing biological material for a series of orthopedic procedures. The growing need for musculoskeletal tissues for transplantation has been due to the development of new surgical techniques, and this has led to a situation in which a variety of hospital services have been willing to have their own source of tissue for transplantation.

The good performance in a bone bank depends on strict control over all stages, including: formation of well-trained harvesting teams; donor selection; conducting various tests on the tissues obtained; and strict control over the processing techniques used.

Bone is the second most commonly transplanted tissue after blood, the main indications for transplant include tumor surgeries, failed replacements, spinal surgeries, arthrodesis and massive bone loss after trauma.

Although bone comes free of cost, maintenance of efficient bone bank asks for an adequate financial support for proper procurement, processing and storage of bone as well as training of personnel and maintenance of records.

Where does bone come from?

Either intra-operatively from fracture neck femur, TKR, or from persons who have expressed willingness to donate in event of death. The bone retrieved can be used upto 2 years after its removal.


Consolidation of grafts into the host bone tissue takes place through the mediation of three biological phenomena: osteogenesis, osteoinduction and osteoconduction. Osteogenesis is taken to be the capacity of live cells (osteoblasts) to maintain the production of osteoid substance, which may only occur with autologous grafts. Osteoinduction is the differentiation of pluripotent cells in the host into osteoblasts, through a series of mechanisms in which the various families of growth factors play an important role. Lastly, osteoconduction is the process in which the canaliculi of the transplanted bone act as a guide for the growth of osteoblast bridges of new bone tissue coming from the host.

A large number of homologous grafts and bone substitutes are exclusively osteoconductive.



Donor Selection


Storage & Processing



HOD responsible for over viewing of bone bank and administration


  • Questionnaire, (general and specific exclusion criteria):
  • Below 18 years and above 80 years excluded
  • Active or recent infection/ sepsis
  • Previous history of TB
  • Recent history of live vaccination (4 weeks)
  • RA/CTD/Autoimmune diseases
  • IDDM/ Malignancies
  • Exposure to radiation/ long term steroids
  • Psychiatric patients

Specific criteria

  • SYPHILIS antibodies
  • Homosexuals
  • Hemophilia
  • Iv susbstance use


Proper registers and documentation for harvesting , with time and date of procurement and storage are required, they have to be maintaine by authorized personel.

Recommended : descrption of tissue, product code, use date, expiry date,


Recipient is assured of receiving a safe bone transplant. The bone screened for bacterial infection prior to storage


  • Deep freezer
  • Autoclaved glass jars with lids
  • Normal saline
  • Label and record book

Fresh frozen allografts
Are harvested and processed by first washing away blood and bone marrow elements completely as possible and storing them at very low temp(-70 to -80 degree c)

Ethylene oxide sterilization- risk of non removal of agent from allograft rendered it unpopular

Simple, high axial load bearing strength, decrease immunogenicity

Need to store at very low temp, freezing alone does not destroy all viruses and bacteria

Apart from infectious diseases, any cancerous disorder, neurological degenerative diseases, diseases of unknown etiology, exposure to toxic substance, disorder which impair bone formation are condraindications


How to use

  • Slow thaw method - approximately 24 hrs prior to surgery the packed graft is moved from freezer to refrigerator.
  • Quick thaw method - in case of emergency warm saline can be used for rapid thawing
  • Rehydration - all freeze dried allografts must be rehydrated with normal saline for atleast 60 minutes prior to use, extended 4 hrs rehydration time is required for any tissue to be cut, shaped or wedged.

Allograft must be used within six hours of rehydration or kept in fridge and can be used within 24 hours

Informed Consent form:

it is mandatory to take an informed consent from the patient that allograft is being used for his/her surgery, all procs and cons shouulde be explained to patient and written informed consent should be marked in file


Bone bank is a great back up for any hospital and orthopaedic surgeon and can be readily used for any adversity intra-operatively after following the proper protocol.


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