Bone grafting

Overview

Bone grafting is a surgical procedure aimed at repairing and restoring damaged or diseased bones. It involves the transplantation of bone material, either sourced from the patient’s own body (such as the hip, leg, or rib) or from deceased donors, to the site of the affected bone. Our skeletal structure provides crucial structural support, with living bone cells continuously maintaining bone strength and repair. When extensive bone loss occurs, as in cases of severe fractures or crumbling bone segments, bone grafts are necessary to facilitate proper healing.

In a bone graft procedure, a surgeon introduces new bone material to the injured or unhealed bone site. This transplanted bone material contains cells that merge with the existing bone, promoting healing and reinforcement. Typically, bone grafting is an integral component of broader medical interventions, such as treating severe thigh bone fractures. It often requires a small incision in the hip to harvest bone material for grafting, with the patient under general anesthesia to ensure comfort during the procedure.

Reasons for undergoing the procedure.

A bone graft procedure may become necessary when bones fail to heal properly following a fracture. This can manifest in various ways:

• Delayed union: Bone fusion occurring at a slower pace than expected.
• Malunion: Bones healing in an abnormal or incorrect position.
• Nonunion: A failure of bone fusion to occur altogether.

Other reasons for undergoing a bone graft may include:

• Bone conditions like osteonecrosis and cancer.
• Bone infections (osteomyelitis).
• Congenital anomalies, such as uneven limb lengths or an unusually small chin.
• Strengthening the jaw (dental bone graft) before receiving a tooth implant.
• Joint replacement surgery, where bone growth may be needed to secure an artificial joint.
• Spinal fusion.
• Trauma, including severe fractures that result in bone fragmentation.

Types of bone grafts

There are several methods for bone grafting, which include:

• Allograft: This procedure makes use of donor bone tissue. To assure the recipient’s safety, bone tissue is cleansed and processed (sterilized) according to tight guidelines for public health services. This kind of graft is frequently used in spinal fusion procedures. It offers a foundation for the development of sound bone tissue.
• Autograft: In an autograft, a portion of your bone tissue is used. The tissue normally originates from the iliac crest, which is the top of your hip bone. In order to access the bone tissue, the surgeon makes an incision. Using your own tissue has the advantage of increasing the likelihood of successful fusion, but there is a limit to how much bone tissue can be gathered. Additionally, the area where the bone graft is harvested may hurt.
• Bone marrow aspirate: Marrow, the flexible substance located within bones, contains stem and progenitor cells capable of accelerating the healing process of bone fractures. In allograft procedures, a surgeon collects a bone marrow aspirate sample from the hip bone (iliac crest) using a needle. This harvested bone marrow aspirate can be employed either on its own or in conjunction with other bone grafts to expedite the bone repair process.
• Synthetic bone graft: This grafting method utilizes synthetic materials crafted from diverse porous substances, with some containing proteins that assist in bone formation.

Risks

Risks are inherent in every bone grafting procedure and encompass:

• Infection.
• Blood loss.
• Chronic pain.
• Scarring.
• Fractures.
• Bone healing issues.
• Failure of the hardware, such as the plates and screws holding the graft in place.

Before the procedure

To prepare for your bone graft procedure, it is essential to have a discussion with your doctor.

• Medication Review: Consult your doctor about whether you need to discontinue any medications, especially blood thinners, prior to the surgery. If you smoke, make an effort to quit before the procedure to enhance your recovery. Disclose all medications you are taking, including Over-The-Counter (OTC) drugs like aspirin. Inform your doctor of any recent changes in your overall health, such as experiencing a recent fever.
• Diagnostic Tests: Depending on the specifics of your condition, your doctor may require additional imaging tests like X-rays, Computed Tomography (CT) scans, or Magnetic Resonance Imaging (MRI) before the procedure.
• Special Preparations: Depending on the purpose of your bone graft, you may need to make additional preparations. For instance, if you won’t be able to bear weight on your leg after surgery, you may need to arrange changes in your living arrangements.
• Fasting: On the night before your procedure, you should refrain from eating or drinking after midnight as instructed by your healthcare provider.

During the procedure

The specifics of your bone grafting surgery can vary significantly based on the purpose of the procedure. It’s important to discuss the details of your particular surgery with your healthcare provider. Your surgery will be performed by an orthopedic surgeon with the assistance of a healthcare team. Here are the general steps involved:

• Anesthesia will be administered to ensure you remain pain-free and comfortable throughout the procedure.
• Your vital signs, such as heart rate and blood pressure, will be carefully monitored by a healthcare professional during the operation.
• The affected area will be cleansed, and your surgeon will make an incision through the skin and muscle surrounding the bone that requires the bone graft.
• In some cases, your surgeon may make a separate incision to harvest the bone graft. This may involve obtaining a small section of bone from your hip, leg, or ribs using specialized tools.
• The bone graft will be inserted between the two pieces of bone that need to fuse together. In certain situations, your healthcare provider may use special screws to secure the bone graft in place.
• Any additional necessary repairs will be performed by your surgeon.
• The layers of skin and muscle surrounding the treated bone will be surgically closed, and if applicable, the area where the bone was harvested will also be closed.

After the procedure

Following a bone graft surgery, you might encounter discomfort, but pain medications can provide relief. It’s important to gradually return to a regular diet, and X-rays may be conducted to verify the procedure’s effectiveness. Restoring muscle strength might require physical therapy. In some cases, blood thinners may be prescribed to prevent blood clots, but certain over-the-counter pain medications should be avoided. Your healthcare provider might recommend a diet rich in calcium and vitamin D. If you notice any fluid drainage from your incision, promptly inform your healthcare provider. Attending follow-up appointments and adhering to your doctor’s instructions are crucial for a complete recovery.

Outcome

The graft material gradually merges (fuss) with the neighboring bone tissue. This integration process may span several weeks or even up to a year. The duration of your recovery will depend on factors such as the size and location of the bone graft, as well as your age and overall health.