Bone bank gives new lease of life

MARK NICHOLLS Donated bone gave mum-of-three Lisa Willis a new lease of life. MARK NICHOLLS looks at how the bone bank at Norfolk's main hospital is helping other patients.

MARK NICHOLLS

Donated bone gave mum-of-three Lisa Willis a new lease of life. MARK NICHOLLS looks at how the bone bank at Norfolk's main hospital is helping other patients.

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Lisa Willis was under 40 when she had her fifth hip operation, a legacy of an injury that can be traced back to a difficult birth. The previous operations - carried out in Leicester - had not been a long-term success and had worked loose to such an extent that bone in her pelvis had been worn away leaving her in constant pain.

But what made her latest operation possible - carried out by consultant surgeon John Nolan at the Norfolk and Norwich University Hospital - is the availability of donated bone.

Now 41, Mrs Willis, who lives at Kettlestone near Fakenham, and is the mother of three grown-up children and has two grandchildren, explained: “A lot of my pelvis had worn away but Mr Nolan was able to use a wire mesh net framework and build up the pelvis for the new hip replacement. That was three years ago and my hip is now fine. It is amazing what he has done and that is because of donated bone.”

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Donated bone was also used to strengthen her femur to be able to take an extended shaft from the replacement hip.

The bone bank at the N&N was originally set up 15 years ago.

It is now “self-sufficient” in that all the bone used in surgery at the hospital is harvested from hip operation patients who donate the femoral head for use in grafting.

In the past the hip ball was thrown away but now it is used for bone replacement to help rebuild sockets, or strengthen femurs, for patients who have lost too much bone through wear and tear for a hip replacement to fit well.

But Mr Nolan stressed: “Before we can accept that bone from a patient they will be screened to make sure they are not high risk from infection.

“There is no risk at any point to the donors, the only difference for them is that they have two blood tests, the operation is exactly the same but instead of throwing the bone away we put it into the bone bank.”

The screening process is undertaken by bone bank co-ordinator Janet Holtaway who will approach a patient before surgery, check their notes and ask permission to use their bone.

While 750 hip replacements a year are carried out at the N&N only 130 suitable donors are found from that, with the rest declined because of a patient's medical history. But it is very rare that someone will refuse to donate,” said Janet. That patient will then give a blood test as part of the rigorous screening process. Once the femural head is donated it is sealed and stored for six months at minus 80C to await the result of a second blood test from the donor.

Mr Nolan explained that when bone is cleared for use and needed in the operating theatre it is broken up into tiny pieces, generally the size of a “crouton” and used in a process called impact grafting. If a hip socket in a pelvis is worn away too much to take the replacement hip's cup, this compacted bone can be used to re-build the socket. A wire mesh is used as the framework and the bone compacted into shape. As it is bone, the patient's body “takes over” the bone and it forms a natural bone cup. “If there is not enough bone on a patient, we can't put a hip replacement in,” said Mr Nolan.

When impact grafting is used, patients are still got out of bed the next day after a hip replacement but do not fully weight bear until six weeks.

Mr Nolan also stressed that no bone from other centres is used on N&N patients.

Last month, 25 UK hospitals were named as having potentially used contaminated bone that had been stolen in America.

“The American bone saw some trusts hoodwinked but as the N&N's bone bank is self-contained that did not and could not happen,” he said. “Any bone in our bank remains under our control and we can reassure all the patients who have received bone that have not used any from America.”

The N&N bone bank also now has an intricate failsafe system built in after an electrical problem led to the loss of a year's supply of bone in 2003.

One recent hip replacement patient was Mary Plummer who is 81 and from Hales, near Loddon. She did not need donated bone but was happy for her femoral head to go into the bone bank.

“This hospital has helped me and I am happy to put something back,” added Mrs Plummer.