Background Information:

What are the other Names for the Procedure?

• Bone Allograft
• Bone Autograft
• Transplantation of Bone

Bone Graft is referred to as Autograft or Allograft, depending on the source of the graft. If the graft is donated by the patient themselves, the procedure is called an Autograft. If the graft is obtained from another person or a volunteering donor, the procedure is called an Allograft.

What is the Bone Graft surgical procedure?

Bone Graft is a surgical procedure that involves repairing and/or replacing damaged bones.

What part of the Body does the Procedure involve?

Bone Grafting can be done on any part of the body that involves bones. The procedure is confined to the affected part of the body.

Why is the Bone Graft surgical procedure Performed?

There could be various reasons for performing a Bone Graft surgery. Some of these are:

• Joining broken bones
• Fusion of spine or other bones
• To aid in better healing of bones, as a preemptive process
• Repair of broken bones that have not healed well

What are some Alternative Choices for the Procedure?

If the bone is severely damaged then Bone Graft remains a gold standard procedure. However, in some rare cases, the physician may choose to permit the bones to self-heal, aided by a combination of oral medications that promote bone healing.

What are the Recent Advances in the Procedure?

Recent advances in the procedure are the use of laparoscopic techniques, and the use of artificial grafts that have reduced chances of rejection.

What is the Cost of performing the Bone Graft surgical procedure?

The cost of Bone Graft procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Bone Graft and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/002963.htm

http://www.surgeryencyclopedia.com/A-Ce/Bone-Grafting.html#b

Prior to Bone Graft surgical procedure:

How is the Bone Graft surgical procedure Performed?

• To perform a Bone Graft surgery, the patient primarily needs a bone that will be used to replace or repair the affected bone(s) or bone joint
• The graft may be obtained from a donor or the patient’s body, and they could be any of the following: Pelvic bone, spine, rib, etc.
• An incision is made on the affected bone, and it is isolated from the neighboring tissue and muscles
• The graft is shaped to fit into the affected bone and is made to stay in place securely, with the help of wires or screws
• The muscles and tissues are repositioned and the skin closed with sutures and bandaged
• In some cases the patient may have to wear a plaster cast to aid in the healing process

Where is the Procedure Performed?

A Bone Graft surgery is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged, as per the instruction of the physician.

Who Performs the Procedure?

An orthopedic surgeon performs the surgery, assisted by an anesthesiologist.

How long will the Procedure take?

The procedure can take anywhere between 1-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for a Bone Graft surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• A physician will request your consent for a Bone Graft procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for a Bone Graft procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Bone Graft surgical procedure?

Before a Bone Graft surgery, the patient may be advised to undergo certain tests. A few of them are:

• Routine blood analysis
• Urine analysis
• X-ray of the affected area
• The doctor may suggest further tests depending on the requirement and health of the patient.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Bone Graft?
• What does the procedure involve?
• How will this procedure help?
• How soon should I get it done? Is there an emergency?
• What are the alternatives to a surgery?
• Would artificial grafts be used for the procedure? Will these be permanent?
• Will normal bone mobility be affected?
• Who are the medical personnel involved in this procedure?
• What are the risks while performing the procedure?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Bone Graft surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure general anesthesia is administered.

How much Blood will you lose, during the Procedure?

Bone Graft is an open surgery. The amount of blood loss is dependent upon the type of procedure and location where it is performed.

What are the possible Risks and Complications during the Bone Graft surgical procedure?

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection
• Accidental injury to the neighboring tissue, bone, nerve, or organ

What Post-Operative Care is needed at the Healthcare Facility after the Bone Graft surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Bone Graft surgical procedure:

What are the possible Risks and Complications after the Bone Graft surgical procedure?

Post Bone Graft surgery the following complications may arise:

• Graft rejection
• Infection
• Non-healing of the repaired bones
• The bone fragments may heal improperly causing alignment problems or mismatched joints

What is the Prognosis after the Surgery?

Most of the Bone Graft surgeries have a very high chance of healing, without problems of graft rejection.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling and redness
• Bleeding or drainage
• Fever
• Dizziness or discomfort
• Signs of infection

What Post-Operative Care is needed at Home after the Bone Graft surgical procedure?

At home, the following post-operative care is recommended, after a Bone Graft surgery:

• Avoid strenuous activities (per physician’s advice)
• Keep the surgical wound clean and dry
• Complete the course of prescribed medication
• Elevate legs while resting to prevent blood clots in the legs

How long does it normally take to fully recover, from the Procedure?

This generally depends on the reason behind the procedure and location of the procedure. Thus, it could take anywhere between 6 weeks to 3 months to completely recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue or bone (if any) taken for further examination, is later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• A part of, or the whole tissue or bone that is removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Bone Graft surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• An orthopedic surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the bone/tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Bone Graft procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA