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A Cost-effective Method for Femoral Head Allograft Procurement for Spinal Arthrodesis: An Alternative to Commercially Available Allograft

Brown, Desmond A. PhD*; Mallory, Grant W. MD*; Higgins, Dominique M. PhD*; Abdulaziz, Mohammed MD*; Huddleston, Paul M. MD; Nassr, Ahmad MD; Fogelson, Jeremy L. MD*; Clarke, Michelle J. MD*

doi: 10.1097/BRS.0000000000000395
Health Services Research

Study Design. A cost-effective procurement process for harvesting, storing, and using femoral head allografts is described. A brief review of the literature on the use of these allografts and a discussion of costs are provided.

Objective. To describe a cost-effective method for the harvesting, storage, and use of femoral heads from patients undergoing total hip arthroplasty at our institution as a source of allograft bone.

Summary of Background Data. Spine fusion surgery uses a large proportion of commercially available bone grafts and bone substitutes. As the number of such surgical procedures performed in the United States continues to rise, these materials are at a historically high level of demand, which is projected to continue. Iliac crest bone autograft has historically been the standard of care, although this may be losing favor due to potential donor site morbidity. Although many substitutes are effective in promoting arthrodesis, their use is limited because of cost.

Methods. Femoral heads are harvested under sterile conditions during total hip arthroplasty. The patient is tested per Food and Drug Administration regulations, and the tissue sample is cultured. The tissue is frozen and quarantined for a 6-month minimum pending repeat testing of donors and subsequently released for use. The relative cost-effectiveness of this tissue as a source of allograft bone is discussed.

Results. The average femoral head allograft is 54 to 56 mm in diameter and yields 50 cm3 of bone graft, with an average cost of US $435 for processing of the tissue resulting in a cost of US $8.70 per cm3 of allograft produced. Average production costs are significantly lower than those for other commonly available commercial bone grafts and substitutes.

Conclusion. Femoral head allograft is a cost-effective alternative to commercially available allografts and bone substitutes. The method of procurement, storage, and use described could be adopted by other institutions in an effort to mitigate cost and increase supply.

Level of Evidence: N/A

The procurement and use of femoral head allografts from patients undergoing total hip replacement are described. A review of the current literature and analysis of overall costs associated with the procedure show the method to be cost-effective.

*Departments of Neurosurgery and

Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Michelle J. Clarke, MD, Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905; E-mail:

Acknowledgment date: November 8, 2013. First revision date: February 21, 2014. Acceptance date: April 15, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: employment, grants.

© 2014 by Lippincott Williams & Wilkins