**9. Conclusion**

250 Recent Advances in Arthroplasty

**PHYSICAL EXAMINATION (CONDITIONS) YES NO** 



 Hb/Ht WBC ESR Glucose Bilirubins Alcaline

 GOT GPT Coagulation Platelets

 HbsAG Anti-HBc Anti-HCV Anti-HIV

Chagas Epstein-Barr

HCV-PCR Lues PPR

accreditation by Ministry of Healthy Quality Control Committee - ANVISA)

Table 2. Screening protocol for muscoskeletal tissue donors.

HIV-PCR

**RADIOGRAPHIC EXAM** 


**EXAM RESULTADO EXAME RESULTADO** 

Urine culture

Toxoplasmos

HBV-PCR

Results: ........................................................................................................................................... ................................................................................................................................................................

Source: Bank of musculoskeletal tissues (BMST), Hospital São Vicente de Paulo - Passo Fundo BMST of the Hospital de Clinicas de Porto Alegre University Hospital (licensed, but awaiting

Phosphatase

1+2

virus

test

is IgM/IgG




diseases?

disease?



 Urine analysis

CMV

 HTLV1/HTL V2

IgM/IgG

There are many differences when comparing the types of graft, with variations as for the source, production methods, processing, uses (block or shredded) sterilisation, storage and cost of the process. Thus, it is essential the implementation of protocols for processing and quality control of all types of bone grafts. This measure will facilitate the monitoring and analysis of the results obtained in distinct surgical procedures, and shall provide grafting material of better quality, thoroughly tested and ready available.

Although there are reports of the use of bone grafts and transplants for many years, many mechanical and biological issues such as physical and chemical composition, incorporation, bone remodelling and immune responses are still incompletely assessed. These issues are still requiring more knowledge and further clinical and laboratory investigations to allow a more scientifically based choice of the graft and appropriate indication to surgical use on any particular situation.

There is no doubt on the importance of bone transplants in orthopaedic surgery, especially in hip procedures. Their results are well-known and, to some extent predictable when its use is carried out by experienced surgeons. It is also indubitable that bone tissue is a biologically privileged material, since several alternative bone grafts can be used quite well. It is undeniable, however, that we still knowing little about many aspects of the host-graft interaction and sometimes seems we are resigned with this situation, when in fact, many studies have yet to be carried out in several ways to attempt to answer questions that sometimes are underestimated, since "most of the time the graft works". For instance, why do 85% of the grafts theoretically integrate? Though it seems a good percentage, how about the other "not so lucky" 15% of the cases? Is it a matter of technique, immune response, mechanical effect or biological feature? Which is the best substitute for autologous grafts? The frozen allogeneic sterile or non-sterile or the freeze-dried irradiated or autoclaved graft? Should a method of definitive sterilisation be employed by the Tissue Banks?

These are just some of important yet unanswered issues that should be carefully investigated and analysed if best clinical responses, increased biosafety and lower complication rates as well as higher scientific basis to precisely and reliably analyse the grafts and surgical outcomes are to be sought.
