Bone Grafting

What is a bone graft?

Bone graft, which is also known as transplanting of bone tissue, is a surgery that uses grafted bone for repairing and reconstructing damaged bones. Bone grafts are used for almost any part of the body.

When a bone gets injured or fractured, a repairing process gets started. As long as the fracture is not intense, the bone cells can repair them. But if the fracture is so severe that loses a great amount of bone, repairing without a bone graft is impossible. Bone grafts can provide a framework for new and living bone growth.

Why is a bone graft needed?

• A primary fracture, which the doctor doubts in repairing without graft. Or a previous fracture that hasn’t been fixed with a good splint or rod.
• Being diagnosed with bone diseases, such as osteonecrosis or cancer
• To perform spinal fusion surgery.
• For dental implantation surgery – if the jawbone has poor quality or less thickness (thin)
• For surgically implanted implants – such as complete replacement of the knee, to help bone growth around the structure.
• Sinus lift – A sinus lift requires raising the sinus membrane and bone grafting onto the sinus floor so that implants can be placed inside.
• Change in nerve site – if the lower alveolar site should be repositioned for an implant; a bone graft is needed.

Types of bone grafts

The bone scaffold in the transplanted bone is the main reason for stimulating bone fusion with a transplant. The bone graft provides a framework for the new and living bone (if the body accepts it) to grow within. Bone graft types include:

• Allograft – used from a deceased donated bone that has been cleaned and stored in a tissue bank. It is usually used for the reconstruction of the hip, knee, or long bones.
• Autograft – used from the patient’s body, such as ribs, pelvis, thigh, or wrist for grafting.
• Xenograft – used from cow’s bone for grafting. This grafting is entirely safe and successful.
• Artificial graft (alloplastic) – this graft is made artificially and has different types.

The type of graft used depends on the injury.

Preparing for bone graft

• The doctor will do a physical assessment and ask about your medical history.
• It is necessary to have imaging such as an x-ray, MRI, or CT scan before the surgery.
• Avoid drinking fluids the night before the surgery.

During Bone Grafting

Bone graft surgery details of every person, regarding the reason for surgery, differs from the others. An orthopedic surgeon performs the surgery with the help of a surgical team. The operation as a whole includes the following steps:

At first, an anesthesia procedure is done, so the patient doesn’t feel pain during the operation. During the process, vital signs such as heart rate and blood pressure will be controlled.

After cleaning the injured area, the surgeon makes incisions in the skin and muscles surrounding the bone.

If an autograft is being performed, the surgeon makes an incision in another limb. This process is performed for bone grafts. By using special tools, the surgeon takes a small piece of the bone. The transplanted bone may be taken from the pelvis, leg, or ribs.

Continuously, the surgeon shapes the bone to fit the transplanted area.

Then, the transplanted bone is put between 2 injured bones. In some cases, the surgeon might fix the bone with a screw, pin, plate, wire, or special cables.

Finally, the skin layers and the muscles around the treated bone, as well as the site of the transplant are sutured.

After Bone Grafting

There might be pain after the surgery, but it will be relieved by painkillers. Do not use over-the-counter medications, as some of them interfere with bone repair.

According to the extent of the injury and other medical conditions, you might go home on the same day.

After the surgery, put a cold compress on the area and keep your body above your heart level. This will reduce swelling, pain, and blood clotting.

You may need an x-ray to make sure the surgery was successful.

Recovery After Bone Grafting

Recovery from bone grafts depends on transplant size and other variables. Healing may take from 2 weeks up to 1 year.

Do not smoke until complete recovery, since it reduces recovery speed and bone growth.

You should refer for suture removal after 1 week or more.

Discharge from the surgical area is expected. But in case of excessive discharge, redness, swelling, pain, numbness, fever, and shivering, inform your doctor.

Usually, the affected area should be held in place, so you may need a splint or a brace.

You should not put weight on the affected bone. You may need physiotherapy to regain your power and muscle flexibility.

You may need to take blood thinner medication to avoid blood clotting after surgery.

Having a diet rich in calcium and vitamin D is beneficial for your bone healing.

Follow the instructions after the surgery to get the best result and recover in a short time.

Bone graft risks

Bone grafts are safe, but they may have some risks, which include:

• Infections
• Bleeding
• Blood clotting
• Nerve damage
• Complications of anesthesia
• Complications due to transplanted bone (very rare)
• Failure of bone repair (unsuccessful graft)

But also, the risks for this operation depend on the exact reason for the bone graft. In addition, using transplanted tissue, medical history, age, and smoking affect operation risks.

Dental Bone Graft

A dental bone graft is a method to increase the bone amount in a part of the jaw. This surgery is performed in an area where the bone is missing or needs more support. A dental bone graft is performed when 1 or more permanent teeth are missing or have gum disease, since both cases result in jawbone loss. A dental bone graft is sometimes performed for dental implants or treatment of jawbone resorption.

Femur Bone Graft

Sometimes the femur fractures don’t heal when fitted or fixed. One of the treatment methods, when the bone doesn’t heal is bone grafts. This method might be used in conjunction with bone stabilization (using screws, plates, or external fixators), or alone. In this way, the bone that is taken from another area of the body will be placed in the unhealed area.

Bone Graft Cost in Iran

The cost of this surgery depends on the volume and type of graft used, the condition and area of the fractured site, the severity of the operation, concurrent operation, the surgeon’s skills, and the location of the surgery. For example, a jawbone graft cost for a dental implant with an artificial graft is about $1,200 but in Iran, it costs a fraction of this amount.

The graft cost for other parts of the body is calculated as part of the cost of the main surgery and cannot be calculated separately.