Current trends in bone grafting and the issue of banked bone allografts based on the fourth nationwide survey of bone grafting status from 2000 to 2004

Background. The Japanese Orthopaedic Association Committee on Tissue Transplantation and Regenerative Medicine has conducted a nationwide survey of the status of bone grafting in Japan every 5 years from 1985. We report here the status of bone grafting from 2000 to 2004, show the trends in bone grafting from 1985 to 2004, and draw attention to the issues affecting banked bone allografts. Methods. Questionnaires devised by the Committee were sent to all educational and training hospitals (2239 institutions) approved by the Japanese Orthopaedic Association. Results. Survey responses were obtained from 1263 institutions (56%). Of these, 875 institutions performed tissue transplantation during this period. A total of 163564 tissue transplantations were performed, and 134782 (82.4%) of them were bone grafts. Of the bone grafts, 76015 (56.4%) were autografts, 53735 (40%) used a synthetic bone substitute, and 4886 (3.6%) were banked bone allografts. The proportion of synthetic bone substitutes increased, and the proportion of autografts decreased year by year. Synthetic bone substitutes were most frequently used for replacement arthroplasty (31%). Fifty percent of banked bone allografts were performed for joint disorders requiring replacement arthroplasty. During this period, 271 institutions performed banked bone allografts, with 210 preserving allografts in their own institutions. Donor selection criteria, processing and preservation methods, and management of the bone bank were not the same in all banks. Conclusions. Most bone grafts performed in Japan during the four surveys were still autografts. However, the proportion of autografts decreased, and the proportion of synthetic bone substitutes increased. The number of synthetic bone substitutes and banked bone allografts used for replacement arthroplasty increased significantly. However, the total number of banked bone allografts reported in the fourth survey was still low. Quality control of banked bone allografts and management of bone banks were not satisfactory, although they were improved.