Bone grafting





Definition

Bone grafting is a surgical procedure that places new bone or a replacement material into spaces between or around broken bone (fractures) or in holes in bone (defects) to aid in healing.


Purpose

Bone grafting is used to repair bone fractures that are extremely complex, pose a significant risk to the patient, or fail to heal properly. Bone grafting is also used to help fusion between vertebrae, correct deformities, or provide structural support for fractures of the spine. In addition to fracture repair , bone grafting is used to repair defects in bone caused by congenital disorders, traumatic injury, or surgery for bone cancer. Bone grafts are also used for facial or cranial reconstruction.


Demographics

Degenerative diseases of the spine increase with age. People over age 50 are more likely to need a bone graft if their condition requires surgery. Traumatic injuries occur most often in people 18–44 years.


Description

Bone tissue is a matrix-like structure primarily composed of a protein called collagen. It is strengthened by hydroxyapatite, deposits of calcium and phosphate salts. Four types of bone cells are located within and around this matrix. Together, these four types of cells are responsible for building the bone matrix, maintaining it, and remodeling the bone as needed. The four types of bone cells are:

  • Osteoblasts, which produce the bone matrix.
  • Osteocytes, mature osteoblasts that maintain the bone.
  • Osteoclasts, which break down and remove bone tissue.
  • Bone lining cells, which cover bone surfaces.

There are three ways that a bone graft can help repair a defect.

  • Osteogenesis, the formation of new bone by the cells contained within the graft.
  • Osteoinduction, a chemical process in which molecules contained within the graft (bone morphogenetic proteins, abbreviated as BMP) convert the patient's cells into cells capable of forming bone.
  • Osteoconduction, a physical effect whereby the graft matrix configures a scaffold on which cells in the recipient form new bone.

The term "graft" commonly refers to an autograft or allograft. A graft made of bone from the patient's own body (e.g., hip bones or ribs) is an autograft. To obtain a piece of bone for an autograft, the patient undergoes surgery under general anesthesia. An incision is made over the crest of the hip bone, a piece of bone is removed, and the incision is stitched closed.

An allograft uses bone from a cadaver, which has been frozen and stored in a tissue bank. Allografts are used because of the inadequate amount of available autograft material, and the limited size and shape of a person's own bone. Bones for allografts are usually available from organ and tissues donated by healthy people who die unexpectedly. Occasionally, allograft bone may be provided by a living donor. Allograft bone is commonly used in reconstructive surgery of the hip, knee, and long bones, as well as cases of bone loss due to trauma or tumors. Using allograft tissue from another person eliminates the need for a second operation to remove autograft bone or tendon. It also reduces the risk of infection, and safeguards against temporary pain and loss of function at or near the secondary site.

To place an autograft or allograft, the surgeon makes an incision in the skin over the bone defect, and shapes the bone graft or replacement material to fit into it. After the graft is placed into the defect, it is held in place with pins, plates, or screws. The incision is stitched closed, and a splint or cast is often used to prevent movement of the bones while healing.

After the bone graft has been accepted by the body, the transplanted bone is slowly converted into new living bone or soft tissue, and incorporated into the body as a functional unit.


Bone grafts for spinal fusion

In surgery of the spine, especially spinal fusion , (also called arthrodesis), surgeons may decide to use bone grafts to assist in the healing and remodeling of the spine after surgery. Normally, small pieces of bone are placed into the space between the vertebrae to be fused, and sometimes larger solid pieces of bone provide immediate structural support. Spinal fusion involves the surgical treatment of abnormalities in the vertebrae, such as curvatures, scoliosis or kyphosis, or injuries (fractures). Bone grafts may be used in spinal fusion surgery involving the lower (lumbar) or upper (cervical) spine. Cervical spinal fusion joins selected bones in the neck.

For bone grafting, an incision is made in the donor's hip (A). Pieces of bone are chipped off and removed (B). The bone materials are then transferred to the recipient area, in this case a femur that has been badly broken, to strengthen the bone (C). (Illustration by GGS Inc.)
For bone grafting, an incision is made in the donor's hip (A). Pieces of bone are chipped off and removed (B). The bone materials are then transferred to the recipient area, in this case a femur that has been badly broken, to strengthen the bone (C). (
Illustration by GGS Inc.
)
This surgery may also be performed by other means, such as metal rods, which would not require bone grafts.


Diagnosis/Preparation

The surgeon does a clinical examination, and conducts tests to determine the necessity of a bone graft. Diagnostic tests determine the precise location of damage. These tests include x rays, magnetic resonance imaging (MRI), and computed tomography (CT) scan. They provide an image of the affected area, and indicate the exact amount of damage that has occurred due to the fracture or defect.

Orthopedic surgeries pose varying degrees of difficulty. The patient is instructed on what will take place during the procedure, as well as risks involved. A consent form is obtained before surgery.

The following activities will help the patient prepare for surgery.

  • thorough physician consult before surgery
  • banking some of his or her own blood in case a transfusion is needed
  • eating well to achieve good nutritional status before and after surgery
  • following a recommended exercise program before and after surgery.
  • maintaining a positive attitude
  • smoking cessation

Aftercare

Pain is normal for a few days following surgery, and medication is given regularly to alleviate this problem. The patient will likely have a urinary catheter.

The time required for convalescence after bone grafts due to fractures or spinal fusion varies from one to 10 days. Vigorous exercise may be limited for up to three months. Children heal faster than adults.

If a spinal fusion was performed, the patient may be discharged from the hospital with a back brace or cast. The family will be taught how to provide home care for the patient. A splint or cast prevents injury or movement while healing.


Risks

The risks for any surgical procedure requiring anesthesia include reactions to the medications and breathing problems. Bleeding and infection are also risks of surgery.

There is little risk of graft rejection for autografts, but there are drawbacks:

  • additional surgical and anesthesia time (typically 30 minutes per procedure) to obtain or harvest the bone for grafting
  • added costs for the additional surgery
  • pain and infection at the site from which the graft is taken
  • the relatively small amount of bone available for grafting
  • surgical complications, such as infection and pain that sometimes last a longer period of time than the primary surgery (up to two years)

Allografts also have drawbacks:

  • Bone variability because it is harvested from a variety of donors.
  • Grafted bone may take longer to incorporate with the host bone (than in an autograft).
  • Graft may be less effective than an autograft.
  • Possibility of transferring diseases to the patient.
  • Potential immune response complications (patient's immune system fighting against the grafted bone tissue). This problem is lessened through the use of anti-rejection drugs.

Normal results

Most bone grafts are successful in helping the bone defect to heal. The extent of recovery depends on the size of the defect and the condition of the bone surrounding the graft at the time of surgery. Severe defects take some time to heal, and may require further attention after the initial graft. Less severe bone defects should heal completely without serious complications. Repeat surgery is sometimes required if the condition recurs or complications develop.

If the bone graft is done on the face or head, the surgeries usually result in a more normal appearance.


Morbidity and mortality rates

Although bone harvested from the patient is ideal, postoperative morbidity is sometimes associated with hip bone or fibula (part of the knee) autografts. Morbidity of allografts is usually related to the graft incorporating more slowly, and less completely, into the body.

In one study of over 1,000 patients who received very large allografts after bone cancer surgery, researchers found that approximately 85% were able to return to work or normal physical activities without crutches. However, approximately 25% required a second operation because the first graft did not heal properly.

Infections associated with bacterial contamination of allografts are rare. However, they can result in serious illness and death.


Alternatives

Despite the increase in the number of procedures requiring bone grafts, there is no ideal bone graft substitute. However, there are a variety of natural and synthetic replacement materials used instead of bone, including collagen (the protein substance of the white fibers of the skin, bone, and connective tissue); polymers, such as silicone and some acrylics; hydroxyapatite; calcium sulfate; and ceramics. Several new products are available or in development. They function as bone graft substitutes or extenders. Demineralized bone matrix (bone that has had its calcium removed) possesses some of the properties that the body uses to induce bone formation. Calcium hydroxyappetite products or coral have structures similar to bone, and act as scaffolding for new bone.

New BMP products are expected to be strong inducers of bone growth (osteoinductive). These new products will be relatively expensive, but will grow bone better than the patient's own bone, eliminating the need for bone graft harvesting. Bone morphogenetic proteins have been extracted from natural tissues and produced in the laboratory to stimulate bone production in animals and humans. Because they do not have the same drawbacks as grafts, surgeons are hopeful that they will soon be able to use BMP and laboratory produced BMP to aid in the generation and repair of bone.

The INFUSE Bone Graft (rhBMP-2) has received Food and Drug Administration approval, and has demonstrated better patient outcomes than hip autografts with regard to length of surgery, blood loss, hospital stay, reoperation rate, median time to return to work, and fusion rates at six, 12, and 24 months following surgery.

Advances in tissue engineering have provided polymer based graft substitutes with degradable, porous, three-dimensional structure. New bone may be grown on these products; the grafts then slowly dissolve, leaving only the new bone behind.

See also Disk removal .


Resources

BOOKS

Beauchamp, Daniel R., M.D., Mark B. Evers, M.D., Kenneth L. Mattox, M.D., Courtney M. Townsend, and David C. Sabiston, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th edition. London: W B Saunders Co., 2001.

Branemark, Per-Ingvar, Philip Worthington, Kerstin Grondahl, and Christina Darle, eds. Osseointegration and Autogenous Onlay Bone Grafts: Reconstruction of the Edentulous Atrophic Maxilla. Chicago, IL: Quintessence Pub Co., 2001.

Laurencin, Cato T., ed. Bone Graft Substitutes. West Conshohocken, PA: American Society for Testing and Materials, 2003.

Lawrence, Peter F., Richard M. Bell, and Merril T. Dayton (Editors). Essentials of General Surgery. 2nd edition. Philadelphia, PA: Lippincott, Williams & Wilkins, 2000.

Lindholm, T. Sam, ed. Advances in Skeletal Reconstruction Using Bone Morphogenetic Proteins. River Edge, NJ: World Scientific Publishing Co., Inc., 2002.


PERIODICALS

Berg-Johnsen, J., and B. Magnaes. "Rib Bone Graft for Posterior Spinal Fusion in Children." Acta Orthopaedica Scandinavic 73, no.9 (December 2002): 260-7.

Cowan, N., J. Young, D. Murphy, and C. Bladen. "Double-blind, Randomized, Controlled Trial of Local Anesthetic Use for Iliac Crest Donor Site Pain." Journal of Neuroscience Nursing 34, no.4 (August, 2002): 205-10.

Kakibuchi, M., K. Fukuda, N. Yamada, K. Matsuda, K. Kawai, T. Kubo, et al. "A Simple Method of Harvesting a Thin Iliac Bone Graft for Reconstruction of the Orbital Wall." Plastic Reconstruction Surgery 111, no.2 (February 2003): 961-2.

Nelson C. L., J. H. Lonner, J. A. Rand, and P.A. Lotke. "Strategies of Stem Fixation and the Role of Supplemental Bone Graft in Revision Total Knee Arthroplasty." Journal of Bone and Joint Surgery American volume. 85-A Suppl 1 (2003): S52-7.

ORGANIZATIONS

American Association of Tissue Banks. 1350 Beverly Road, Suite 220-A, McLean, VA. 22101. (703) 827-9582, fax: (703) 356-2198. E-mail: aatb@aatb.org. http://www.aatb.org/menu.htm .

National Institutes of Health. 9000 Rockville Pike, Bethesda, MD. 20892. (301) 496-4000. Email: NIHInfo@OD. NIH.GOV. http://www.nih.gov/ .

North American Spine Society. 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) Spine-Dr. E-mail: info@ spine.org. http://www.spine.org .


OTHER

American Academy of Orthopaedic Surgeons (AAOS) and American Association of Tissue Banks (AATB). "What Can You Tell Me About Bone and Tissue Transplantation?" 2001. [cited March 19, 2003]. <http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=53&# 0026;topcategory=About%20Orthopaedics&all=all> .

U.S. National Library of Medicine and the National Institutes of Health. MEDLINE plus Health Information. 2003 [cited March 13, 2003]. http://www.nlm.nih.gov/medlineplus/html .


Lisa Christenson, Ph.D. Crystal H. Kaczkowski, M.Sc.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Bone grafts are performed by orthopedic surgeons, neurosurgeons, craniofacial surgeons, and periodontists. These physicians have specialized training in their field of expertise. They have completed additional education beyond a general medical residency. A physician becomes board certified after completing training in a specialty area, passing examinations, and meeting certification requirements. To become certified, the physician must:

  • Complete the education required for a medical doctor or doctor of neurosurgery.
  • Complete three to seven years of training in a residency program in the specialty field.
  • Pass a written, and sometimes an oral, test given by the specialty board.
  • Prepare for periodic recertification (required in most fields).

Specialty boards certify that physicians have met certain standards. Not all specialists are certified; certification is voluntary.

The surgeon and his or her surgical team will perform the surgery in a hospital on an inpatient basis.

QUESTIONS TO ASK THE DOCTOR


  • What should be done prepare for the graft?
  • Who will provide education about the grafting process?
  • How many attending surgeons are available to do this type of surgery?
  • How long is hospitalization necessary?
  • How long will recovery take?
  • When will it be safe to resume normal activities?


User Contributions:

Peter Jones
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May 5, 2006 @ 3:03 am
i found your site very informative.
dafer
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May 5, 2006 @ 2:14 pm
article is good ,simple and easy to understand but i need more about types and exact time for bone grafting
thanks ...
Debra Roan
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Jan 6, 2008 @ 7:19 pm
very good article. what causes hip pain post spinal fusion/ had surgery in 2006 and still have pain in my back if i over do things.the hip pain seems to be getting worse and the lortab i take isn't helping much. any info would be greatly appreciated.
Jan W
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Oct 8, 2008 @ 11:23 pm
Does anyone know the symptoms of immune response graft rejection?
I have had a radial osteotomy with an allograft 6 weeks ago, and have been running a low grade fever for at least the last month. Radiograft taken today showed graft appears to be gone and a large black space has appeared since radiograph taken a month ago. The doc didn't mention it, or the fever I reported by phone two weeks ago. Operated area is one degree over other side when taking temp of skin.
dr.ramesh
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Nov 23, 2008 @ 2:02 am
I am dr.ramesh doing Phd in veterinary surgery at madras vet.college, chennai, india. i found this site very useful. I would like to know more about infusebone graft.since i would like to takeup research work on orthopaedic particularly in bone graft,i need more information about the infusebone graft.
Maverick
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Mar 15, 2009 @ 1:13 pm
My doctor has to take bone from both hips due to the amount of bone needed to repair my fractured fibula. For those of you who have had bone graph from the hip, how long did it take before you could bare weight on the hip that the bone was taken from? Wondering since I still can not bare weight on my left leg for quite some time to come. Thanks for the response.
Howard
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Jul 19, 2009 @ 9:21 pm
What kind of food should you eat to help a bone graft heal. Thank you and have a blessed day.
Kathy ODonnell
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Jan 20, 2010 @ 7:19 pm
I had a radial osteotomy with an allograft Oct 5, 09. I now have developed cyst-like lumps from the surgery site to the ends of my fingers. They appeared overnight. What could this be?
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Mar 13, 2010 @ 6:18 pm
Hi Kathy I am on here trying to research the exact same thing for my Mother who had a similar procedure last April and now has the same cysts you describe. Did you get any answers and are your cysts still an issue. Thank you.
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May 4, 2010 @ 7:07 am
23 years after bone graft surgery,the back fusion was successful. However, the donor has produced a pinched nerve that causes pain 24-7,(nerve burning all the way to the foot). I have had management (facet injections, nerve / steroid injections with no relief. I have been offered the option of 1. a electrical stimulator, or morphine pump to control the pain.

Where do I go from here?? Where are the specialist that deal with bone graphs gone bad?
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May 22, 2010 @ 6:18 pm
I had a bone graft from my hip in september 2008 for spinal fusion for the c5 and c6 vertabre.My neck is fantastic now except a few migraine's every now and then,but my hip pain in the colder weather is awful it seem's to be getting worse.I need to have more fusion in the lower spine in the coming years and I am more scared about getting another bone graft from the hip than the fusion itself.
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Jun 10, 2010 @ 10:10 am
I had a cervical anterior discectomy and fusion two months ago. My Dr. did a bone graft from my hip for this surgery. Since having the surgery I have had a piece of bone fracture from my hip. I am in excruciating pain and now have to see another Dr that specializes in hips. Has anyone else had this happen? And could u tell me ur outcome plz!
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Jun 22, 2010 @ 9:09 am
My question is, I'm going to be having Alower spinal fusion on the L4-L5 in July. I'm hearing or should I say seeing a lot of complaints about the hip pain not the actual pain where surgery was really needed it's amazing. Would you all suggest getting a donor insteadt of getting graft from self. Please give me some imput just want to make the right deciesion. Thanks to whoever responds
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Aug 26, 2010 @ 5:17 pm
I have a giant cell tumor on the hand and the two bones and knuckles are almost all the way gone. They have said they could do a bone gragh from my hip and one of my toes. I have never had surgery before and I don't know what to expect but pain and not being able to function.If anyone could shed some light on what to expect, it will be greatly appericated.
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Oct 24, 2010 @ 12:12 pm
HY I AM ASHWIN FROM JUNAGADH CITY,STATE-GUJRAT,COUNTRY INDIA. I WAS MET WITH AN ACCIDENT ON SEPTEMBER-2008. MY RIGHT LEG WAS FACTURED VERY HARDLY. ON MAY-2009 BONE GRAFTING WAS OPERATED ON ME.THEN I GET COMPELETLY RECOVERY IN 6 MONTHS AFTER BONE GRAFTING SURGERY.NOW I AM ABLE TO DO ALL TYPES OF WORK. AFTER SURGERY I HAD COMPLETE MY DIPLOMA MECHANICAL ENGINEERING AND I AM NOW STUDING BECHLAR OF ENGINEERING(MECHANICAL).
Thomas Canata
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Nov 14, 2010 @ 8:20 pm
Does anyone know what the healing time is on a cmc joint fusion with doner bone graft? I also had a screw placed within thumb because the first fusion did not work.
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Dec 31, 2010 @ 11:23 pm
My husband just had surgery 1 1/2 weeks ago. He had a fusion from his l-3 to l-5 AND THEY USED CADAVER BONE PLUS bpm. hE HAS GOTTEN SOME BLISTER TYPE RASHES ON HIS BACK AND LEG...ANY IDEA WHAT THIS MAY BE? I CANNOT SEEM 2 FIND ANYTHING ABOUT IT.
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Jan 24, 2011 @ 2:14 pm
Lindsay, my husband also had cadaver bone grafting at the time of his fusion Nov 2, 2010.
Since then he has had severe rash like welts on his back, legs, head, lips, face, genitals, And the list goes on and on. Several trips to ER to no avail.
His Dr. has diagnosed it as an allergic reaction to the Titanium hardware, and that after 6 mos
the hardware can be removed. WTF! I know that it has to be from the cadaver bone graft. Who in their right mind would consider putting cadaver parts into an alive and healthy person? Totally MORBID! Hopefully your husband doesn't have the same problems as mine.
mary
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Feb 18, 2011 @ 1:13 pm
Shannon,

I had a l-4-S1 lumbar fusion w/ titanium and cadaver bone. The site where they placed the cadaver bone actually fused faster than the titanium. Many people in the medical field use cadaver bones and it is standard practice if one can not get enough bone from the pt. I am thankful to the person who donated their bones to help my unhealthy ones. I am in the medical field and have never heard of a complication directly related to the placement of a cadaver bone.
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Mar 22, 2011 @ 11:23 pm
Hi Cindy I had a l-4 l-5 fudsion done on jan 18 2010. They did a bone graph on my left hip.
I am 14 month out of my surgery and i am worse then i was before. I still cannot sit back in chairs, sofas hard to drive it hurts terribly. I cannot stand straight nor can i walk well without pain going thru my lower back hips and down both legs. As far as the bone graph i have alot of pain from it not even my pain pills help. They say everyone goes thru it different but i would research it more before you have it done. It is such a risk.
Jeannie
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Apr 4, 2011 @ 1:13 pm
My mother had an accident in which her lower leg was broken in 5 places. One of the pieces of bone is gone which leaves a gap. She had a rod put in the leg to hold the bones together and to keep her lower leg stable. She can only put 30% weight ont he leg because the rod is not large enough to bare her full weight. She walks with a walker. 9 months later and no healing of the bone has taken place. She is now considering a bone graft. What is the success rate of bone grafting in traumatic bone injury of the lower front of the leg. My mother has no other health issues.
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Apr 11, 2011 @ 6:06 am
Pls,i'm student nurse,i want u 2 enlighten me on d indications of bone grafting
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Apr 15, 2011 @ 7:19 pm
I so appreciated the information, am going in for a second operation, am so afraid I have a crack and am told it's because of age I have reason to believe that last April I had a myelogram and a got stuck with the needle i was in so much pain I cramped and almost fell off the curney no one wants to touch that issue, and with the first surgery the surgeon used both hips so I cannot donate my own autograft and what I have read about the aullograft and BMP am freaked out but if I don't get this fix am afraid one day i will not be able to walk with the pain i have now . The surgery took 15 hours, the new surgeon couldn't beleive it and i also had a blood transfusion, and my body took longer than most to recovery so now with the second surgery I feel it's might take that much longer although I have lost alot of weight since the last surgery I still don't feel am in that good of shape, never the less I found your information very helpful to me, I have asked most of the questions and only two questions were not answered recovery time and resuming back to normal activities might not be something that will happen since it's the second time, and the doctor sort of mentioned the Possiblity of me not returning back to work.
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Apr 15, 2011 @ 7:19 pm
I so appreciated the information, am going in for a second operation, am so afraid I have a crack and am told it's because of age I have reason to believe that last April I had a myelogram and a got stuck with the needle i was in so much pain I cramped and almost fell off the curney no one wants to touch that issue, and with the first surgery the surgeon used both hips so I cannot donate my own autograft and what I have read about the aullograft and BMP am freaked out but if I don't get this fix am afraid one day i will not be able to walk with the pain i have now . The surgery took 15 hours, the new surgeon couldn't beleive it and i also had a blood transfusion, and my body took longer than most to recovery so now with the second surgery I feel it's might take that much longer although I have lost alot of weight since the last surgery I still don't feel am in that good of shape, never the less I found your information very helpful to me, I have asked most of the questions and only two questions were not answered recovery time and resuming back to normal activities might not be something that will happen since it's the second time, and the doctor sort of mentioned the Possiblity of me not returning back to work.
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Apr 20, 2011 @ 10:22 pm
Hello, I had my bone graft done Thursday 14th, on my lower left leg. After surgery it has a VAC machine on it to enable faster tissue healing. The VAC was changed on Monday 18th I got to see what it looked like. The bone was packed firmly into the cavity. Today the VAC has been changed and the firm pack of Bone I saw on Monday, now looks dry and has cracks in it. Do you think this is a normal part of the healing process? I am being discharged from hospital today, with a portable VAC machine. Looking for to your opinion please. Regards
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May 3, 2011 @ 9:21 pm
My husband 52 yrs old was injured at work when he shattered his elbow in a fall. He had emergency surgery at time of accident and had alot of hardware to replace pieces they could not put back together. He was in constant pain, but managed to return to work under pressure from ins and job, doctor release to full work. He continued in pain, bearing it and working. The Dr felt his pain was mostly due to a screw that might be "catching", so he admits my husband for 2nd surgery. In the second surgery, he removes not only the screws, but the plate. Says he is not sure how it will work out! I am shocked he removed the plate. I feel like it is not a good idea, but I am not a Dr. My husband is surprised too, but his pain is much relieved, so he is happy. After only a few weeks recovery, he is released to work, light duty and sent to theraphy where he is lifting weights and working elbow. His Dr keeps upping his weight limit up to 30lbs. My husband is soon in much pain again. X-ray shows nothing. Again he goes in and is x-rayed this time the ulna has a huge fracture, and is mis aligned, Now doc says do not lift anything heavier than a fork! Sends him to see if he is good candidate for complete elbow replacement. The referred Dr. says no. Elbow replacement is mostly for old ladies who only want to bend their elbow and not for someone who wants to return to work and lift more than 4 lbs! So, Dr #1 knew this, didn't he??? So, why send us on such an errand? I trust consult more, and I (not patient) perfer to try him. My husband has appt with Dr #1 this am (1 day after futile appt) and he is scheduled for surgery#3 on his arm, with orig Dr. Dr wants to do bone graphs taking bone from hip. My husband dosen't like to cause waves, so he accepts this. He is worried about his job, and wants to be well asap. I am afraid of rushing into this. Your opnion/opinions needeed immediately! I am so worried!
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Jul 3, 2011 @ 7:07 am
I had a bonegraph done on my iliac crest to replace bone in my foot/ ankle on June 1st 2011, everything seemed to be ok but 3 weeks after surgery i developed a hematoma at the area of the iliac crest which was very painful and i was back in the hospital for 4 days my question is how long is this recovery to my stomach area because i have to be so careful the way i sit or when i go to the bathroom are all these symtoms going to go away in time and will i be normal so to speak
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Aug 8, 2011 @ 3:15 pm
I need to have a bone and nerve surgery, how can you assist me to get a good and reputale orthopeadic surgeon at a good rate.
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Aug 13, 2011 @ 6:18 pm
I like ur site, but i need to be enlighten on this issue, i have a lost of bone on my leg, and the doctor said i will undergo opretion but is plating so i want to know how long i will be hospitalised.
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Aug 26, 2011 @ 10:10 am
Am I a good candidate at age 62 for a bone graft of the hip for AVN?
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Oct 18, 2011 @ 10:22 pm
Does anyone know the healing time from having plates and screws put on broken ribs. It has been 7 months and still can't stand to sit or stand for long periods of time because of the pain and now out of work again the only way to be comfortable is to lay on side
Donna
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Oct 22, 2011 @ 11:11 am
I am starting week three of a bone graft due to removal of golf ball + size Giant Cell Tumor in my rignt tiba. Two months prior to bone graft the tumor site was cleaned aggressively and filled with bone cement for two months of healing. The choice was made to use the RIA method of bone harvesting. This method of autograft drills into the big ball of the femur and down to the knee with one or more passes. The bone material that is drilled out is vacuumed into a filter until the proper amount is harvested. This material is then packed into the space left vacant after removal of the bone cement. The entry site (more like a puncture than an incision) was very minimal and I can already lay on that hip with very little pain. This is a new procedure (five or so years) and I recommend asking about it for anyone needing an autograft bone harvest. I have experienced much pain but after two weeks of rest and healthy food I am well on the way back to normal. I am 60 years old and the choice of RIA over Iliac Crest was the best for me.
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Nov 3, 2011 @ 8:08 am
As a teenager I had a bone cyst that was filled with cadaver bone that I was told was radiated at the Bethesda Bone Bank. I have developed chronic lymphocitic leukemia. There is no family history. Is there a link between the cadaver bone and cll?
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Nov 16, 2011 @ 6:18 pm
I got a tibial plateau fracture June and surgery to put in metal and cadaver bone. to fill in a compressed area. I was almost ready to walk when I developed a staph infection causing more surgery to remove metal and bone. A third surgery was required last week to remove "spacers" and check infection. (I've been on IV antibiotic for 40 days). Problem: now the incision is bleeding and I was told it was the synthetic filler mixed with antibiotic and blood. Has anyone ever heard of this? I really don't understand what's going on and wonder how much of a setback this is.
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Nov 22, 2011 @ 10:22 pm
I want to get the knowledge about mechanical properties of medical artificial part.
I design knee joint
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Nov 24, 2011 @ 12:12 pm
my son broke his wrist back in april and had a plaster for few weeks on it, after weekly checks by the hospital on this i was referred to th sick kids hospital with him, they then told me he had developed a cyst between the bones which was causing the bone to crumble, they then did an m.r.i scan to check this and said they needed to operate to do bone graft, then they did a biopsy and was taken back in to theatre a few weeks later and the bone graft operation was performed and the cyst removed, since then we have been back in every 2-3 weeks to have it checked, this has showed unsuccessful as the cyst has returned and caused more damage to the area that the surgeon repaired. now i am being told that a further operation to inject more bone graft into the affected area and a steroid injection to stop the growth of the cyst will be performed tomorrow. i am completely unhappy with this and do not know y they are just wanting to try n stop the growth other than remove it, and why has this re-occured, and is it likely to happen agen in any other area if my son were to break any other bone, i am totally confused as to what is going on but just feel as tho i am being fobbed of with if"s and but"s,, no-one seems to have any answers to my questions, and also that if the 1st hospital should have noticed this cyst in there x-ray they did when they confirmed the break.
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Nov 27, 2011 @ 1:01 am
I will be haveing a bone graft done from my Iliac Crest to my wrist. The wrist had a scafoid excision and a 4 bone fusion 1 year ago and this has failed and it is bone on bone now. On December 19th 2011. I will be having my surgery and I wanted to get details on what to expect fron the Iliac Crest bone graft. How long will I be in the hospital? How painful it this operation? Can I bare weight on this leg right after surgery? How long is a hospital stay normally for this proceedure? Please if someone can please give me an idea either from past experience or from a Dr. who probably hasn't a clue how to answer most of these questions becuz he has never gone through this.
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Nov 27, 2011 @ 2:14 pm
HOW LONG DOES IT TAKE TO HEAL THE BONE GRAFT?? IT HAS BEEN 8WKS AND THERE IS STILL ALOT OF PAIN. PLS. LET ME KNOW. THANKS IN ADVANCE!!!
KENT PARIS
jenny
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Dec 12, 2011 @ 2:14 pm
I had a skin graft fitted into my front tibia which the bone had gone through so only way to seal wound was by skin graft - four years later my skin graft has become up in red cherry clear clusters of bubbles right on the bone area - i am getting fevers too. I went to my GP who gave me anti-biotics but am worried the bubble will burst and my bone will be exposed - what should i do?

Jenny
tracy
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Dec 15, 2011 @ 3:15 pm
Go back to your g.p.if the antibiotics have not worked ,best to get it checked .
ricky wilkins
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Dec 18, 2011 @ 1:13 pm
if a cadaver bone is used in a spinal fusion does it need BMP to fuse with patients bone.or will it fuse without BMP.
Ray
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Jan 1, 2012 @ 1:13 pm
Had a tibia fractured in 1999, a plate was fixed 2000 I was discharged months after, sometime when i walk a lot or stand for 2 hours or more I feel a very sharp pain, I still think there is more to do to make me feel better, the place is still in my leg, i lost some bones and would be considering a cadaver, but i live in third world where people never want to talk about their health issues.. Please any advise will really help me go a long way...

rgds
Amber
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Jan 6, 2012 @ 6:18 pm
Bone Graft BMP
Please read article about bone graft, especially, the BMP at the bottom of the first article.
kevin kennedy
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Jan 29, 2012 @ 12:12 pm
I broke my fibula 17 weeks ago and im just getting told i need surgery now that isnt right as the doctors first didnt sit the bone right and took 5 days until that got fixed then they tell me i need surgery now as ive been out of a cast 5 weeks , they have wasted 10 weeks of my life by not telling me i needed surgery 17 weeks ago. what should i do, should i claim after surgery
dolly
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Jan 29, 2012 @ 12:12 pm
cant find the info on what makes your leg hurt when you stand or walk after bone was removed from hip to use in back surgey ,surgey was done on the 1/5/12 hard pain didnet start till 12/23/12. thank you
rose brooks
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Feb 12, 2012 @ 11:23 pm
what kind of bone graft does a dentist use for dental implants? after i had the bone graft done it got infected and i got cellulites which a specialist say was caused by the bone graft. and does a dentist have to have special training to do this procedure. the dentist is saying that he didnt cause this and admit he did anything . would you give me some reply to these questons thanks rose brooks
Crystal, age eleven
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Feb 29, 2012 @ 7:19 pm
My uncle had a bone graft to fix his stapes*, *(pronounced like staples w/out the L) which is a bone in the ear, because they were not functioning properly. He can hear just fine but now my cousin Daniel is deaf in one ear! are the two related?
P.S. My uncle had the surgery before he had kids.
Anil
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Mar 15, 2012 @ 2:02 am
I have multiple fracture in my left ankle from last 9 months. since that ihave infection in that area. On 10-02-2012 dr. did a bone grafting in my affected area & infection is still there. My question is can we do bone grafting in infected area ?
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Apr 19, 2012 @ 8:08 am
I had a lower leg fructure July2012 and had some screw and blades inserted noe after nine months i was told that the bone is refusing to fuse back and a bone grafting had to be performed .i need to know how long will it take to heal especially where the bone was taken from?
gideon
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Jun 23, 2012 @ 2:02 am
I found your site very intresting,i got a broken fibula n tibia bone two year back,the bone got infected with poor management,it was detected that tibia bone is healed,but the fibula was badly affected. The debiris was removed n plastic surgery was done to cover the exposed part,have been placed on antibiotic to last for 30 days.The Dr said the gap is too wide,so i will need bone graft from my hip both side. I will like to know how long will the healing take effect after the grafting. Also want to know if there is diet or exercise that could facilitate my healing.
Mary
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Jun 26, 2012 @ 6:06 am
I had a lumber fusion in L 4-5 along with Screws and a plate going from L3-5 in July 2009. Since then I've had nothing but severe pain in my lower back, burning pain and numbness all they way down my left leg to all but my big toe. I cannot walk, sit, or stand for any long periods of time past 20 min. I have been considered disabled since the surgery and live on 8 pain pills a day which consist of a extended release hydrocodine and acetaminophen 60 mg and Vicodin 10 plus neurotin and Valium to help me sleep at night. None of these are helping the pain. I go thru a managed pain clinic and have been advise against the morphine pump and been told by a second neurologist that nothing can be done to help me the nerve damage that happened during surgery is to severe. Now I hear there's been a recall on the grafts that have been used in this type surgery and cannot get information as to what was used in me. I do know it was not my own bone graft from my body. How and who or where do I get help from here? I'm only 57 yrs old a have lost the ability to enjoy many many things I've done in the past including even playing with my grandchildren. Even my own family thinks its all in my head even after hearing the second opinion from another neurosurgeon.
cindy026
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Jul 5, 2012 @ 5:17 pm
I had the first surgery in a 2 part acl reconstruction with the bone graft off the illiac crest. Now at 3 weeks post op, the knee is fine but the graft site is causing pain when I walk, sit too long and especially when I get up in the morning, any idea how long recovery takes
Lola
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Jul 10, 2012 @ 6:18 pm
Had 3 lumbar fusion surgeries in year and a half. In total 6 bone grafts from hips, 6 titanium plates, 4 cages and 12 screws. Have had hip, leg pain, burning, numbness 8 months later. Dr says everything looks fine on X-ray and ct scan. Finally dawned on me it may be from all the bone the dr took from my hips. This site has been very informative and I feel so bad for everyone experiencing pain.I too am disabled, on pain meds, injections and am 57. Everyone is sick of me complaining because the rods from L2-S1 were supposed to make everything better. Am sad for all, but glad to hear your stories. Going to hip Dr thurs to have X-rays of hips and discussion, then back to Dr who did my fusions. He is very competent and I recovered nicely otherwise. I hope to get some answers so my husband and friends and family don't think I am complaining for nothing. I have a very high to,erance for pain and take way too many meds. Good luck to you all!
Larre
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Jul 13, 2012 @ 10:22 pm
Gidion I would like to know if anyone has responded to your questoins number 50 dated jan 23 2012
Cherie
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Jul 14, 2012 @ 3:03 am
Hi. My brother has accidentally clamped his left thumb. Initially the school doctors asked him to take cloxacillin to swell the finger and for the abscess to come out. After a few days, we decided not to take the medicine again since the pus is so smelly and we begin to think that the finger might rot. This day, they consulted a doctor and referred us to orthopedic for bone degrafting. How serious this may be to require such procedure. Thank you very much for your help.
diana
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Jul 15, 2012 @ 1:13 pm
Hi Rhonda I recomend that your husband take it slow, they can't fire him is against the law, I went for surgery to repair my right wrist dr said was one surgery and I will go back to work, he also had to do a bone graft from left hip first surgery was a disaster knowing that I need it a second surgery he sent me to physical therapy, the graft didn't work after a month from therapy my bone was hanging from wrist and worse pain then before the surgery the physical therapist and director of her clinic took a picture and said in the whole time I,ve neen a therapist I have never seeing nothing like it, she sent me back to my doctor, he tells me in my face oh I wasn't to honest to you, you need it a second surgery he also wanted me to go back to work asap, I said you know what my attorney will be contacting you, right away he gives me a note for work that I'm not able ti work and schedules a second surgery this time he needs another bome graft from right hip, I knew the red flags but think is to late I need to go back to work, second surgery another disaster, I go for the 3 rd surgery and tell you will not get bone from me anymore, on my 3rd surgery my tumb tendon is completely damaged and he have to take a tendon from index finger and place it on my tumb, as you can understand the 4,5,and 6 surgery was performed by another doctor this happened on 2003 on I'm still not able to work the insurance have tried to close my case I keep protesting, I can't be on the pc for more than 3 hours I can't lift more than 5 pounds repetitive, the bone graft was in 2003 I'm still in!! pain I can't sleep on my sides and when I swip the floors the pain is very bad I live now in Illinois and at the end of this month I'm going to wash state for another evaluation, believe me since this happened my life haven't been the same I tell you I'm worst than before the surgeries, I'm in constant pain, I can't do the things that I used to love doing, please take your time
you have the right to a second, 3rd opinion life is nothing without your health, stop worrying about work and take your time oir Father in Heaven haven't forsaking me I was getting a divorce at the same time all this happen and living with less than $1000 with my 2 year boy and until now we had food a roof over our heaf and just as I was working, we take our life for granted we trust more in men which are not perfect than our own creator who feeds the birds and the beast in the fielfd, tell your husband to take his time and not rush, I wish I can go nack on time, but is late for me, life is much more than a job, blessings.
judy kuhn
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Aug 3, 2012 @ 6:18 pm
I am 2 months post bone graft for a fracture to my left heel due to osteomylitis. I'm still having considerable pain especially with walking. My ankle swells and this causes additional pain. Is this unusual? I don't take narcotic pain meds (they make me sick) and am using Advil and Flexiril but it's not effective. I am fully weight bearing according to the schedule my surgeon set for me. I do have a history of lung cancer but a bone biopsy during surgery showed no cancer cells. Thank you for your help.
Sheryl
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Aug 9, 2012 @ 3:03 am
In 2005 I had a spinal fusion L4/5 with a graft taken from my hip and then secured with a cage and screws. I had ongoing pain to my lower pain and numbness down my legs which was ongoing for about 18 months to two years. (Sciaticia) That is all gone now and thankfully I could do all the things I used to do. Now, 7 years later, I am suffering from chronic pain to the graft site on my hip. It is generally only in Winter but it is agony. I think in hindsight taking your own bone is setting you up for future arthritis and alot of pain to the graft site. I am hoping there is a way of getting on top of the agony. I would recommend avoiding grafting your own bone.
evzso
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Aug 17, 2012 @ 3:15 pm
In order to have dental implants my dentist said that I needed some bone graft. He recommended the site of the harvest the skull, top of head , I guess. He says that it is much better than the usual hip bone harvest (no visible scar etc,) I'd appreciate if one of the experts could give me some advice on this. I find this quite morbid (I never had any surgery before). What are the risks ? How big a surgery is this? Thanks.
Sue
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Aug 21, 2012 @ 8:08 am
I am wondering if I would/could be a candidate for a bone graft surgery to replace my clavicle bone. In 2010 I took a fall at work, landing totally on my right shoulder nothing serious at that time but bumps and bruises. Nine months after this fall while I was at work I noticed a lump in my neck and it was at time difficult to swollow. I went to see my doctor, who then made me get an MRI which in turn showed that my clavicle bone was in my neck. Went to see a cardiothorasic doctor who in October of 2011 removed the head of the clavicle bone and did what was needed, stayed off work for several weeks and returned to my job as a cook at a daycare and on my 3rd day back as I was wiping down counters I heard a pop and found out all the work that was done come undone. So the next surgery was in January of 2012 to put in a titanium plate in my neck and off work for several months and am having issues with pain and movement and now the x-ray shows that the plate has shifted and now will discuss the next step. The doctor told me that we are dealing with an area that has constant movement and with all the holes in the bone from screws and reattaching ligaments and tendons. So now they are trying to figure out what to do next. I was thinking a possible cadavar bone graft might be an option.
claire
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Aug 24, 2012 @ 3:15 pm
Back in Feb 2000 I had broken my lower back in 3 places. The surgeon had to take a piece of my hip bone to fuse one my vertibres. I was 24 at the time. All healed pretty well pretty quick, including the 2 rods and 4 bolts that are still in my back. I am now 36, and today my back is in pretty bad shape. Mind you i have always been atletic and in great shape. I have done nothing to compromise the health of my back except may be my job as a bar tender and standing for long hours. But i have to say the worst pain that I experience of all is the hip / bone graph. I cant even lay on my left side any more and more daya then not the pain brings tears to my eyes just to touch the area. I go to see a pain specialist on monday and start my quest of doctors from there to see how to fix this mess. I dont recommend using your own bone knowing what I go through and knowing that I'm not the only one out there.
shauna
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Sep 3, 2012 @ 2:02 am
I had my upper neck fused after a bad car accident when I was 17yrs old, I am now 41 and the last 3-4 months the area where the bone marrow was removed from my right hip area had got a hard, painful knot and it never goes away. My question is what could this be and what can I do to ease the pain &/or the hard knot. I don't have insurance so can't go in as I would like to.
mukesh
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Sep 19, 2012 @ 3:03 am
what exercise should do? and is it risky to do operation in rainy season?
cynthia huston
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Nov 2, 2012 @ 4:16 pm
Weather has nothing to do with it. I've had 4 spine surgeries since 2005, C-2 down to C-7. Just found out they are wanting
to go for the entire sciatica and up, how far I'm not even sure. Only for the fact I feel I'm going to wait till I DROP
before I let them touch me any more! Reading everyones posts is so sad, we are all connected by the pain that we are left in
by the very people who promise "DO NO HARM", but it must be ok to leave us in unexplained pain forever. If you do seek some
kind of solace in treatment (meds) oh, my God, you're an addict! Well, I didn't to this to myself, some highly educated, highly payed, Dr. told me he could make me better, that he did these surgeries all the time, well maybe he just had his first bad day when they gurnied me into the OR that morning,I'll never know but my life is focused on dealing with pain,
the hip which alot of you talk about, but no Dr. I found acknowledges unles it's the ball and socket.My iliac crest, the
harvest place of choice just fell completely apart, and left a gaping visable through the flesh hole. No one feels responsible so now what? Another lawyer, another opinion, another fight for something someone else did to me.. I believe your own bone is the best to use, after that who knows pick you poisin
ed J
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Dec 1, 2012 @ 11:23 pm
i had a bone graft from my hip to repair a bone infection in my upper tibia. it has been 3 weeks now and the pain from the hip is much lessened. i stopped using narchotics to get some sleep finally this week. i found the pain at the hip to be horrible. the graft site at the tibia is iching a bit. oxygen therapy is my savior. my leg/knee had a total dislocation 15 years ago and does not heal well ever since. why my orthopod did not do a flap still confuses me.bone infection was on the front of the shin where there is very little meat or blood flow. i am sure if i did not have the oxygen therapy i would be in big trouble. 60 dives of 100 minutes to clear the original infection and heal the debridement site. 20 more dives to heal the bone graft. i hope to be back to work in three weeks
J. Wilkinson
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Mar 25, 2013 @ 2:14 pm
I had BMP graft along with titanium rods, clamps, etc on L4, L5, & S1 about 5 yrs ago. Pain in low back, hips &legs now so bad that I can barely perform daily activities, can only be on feet a few minutes at a time and have problem lying down to sleep. It has been increasing as time goes along. Tests are not telling my doctors a thing. Any thoughts on why this is happening?
Keith Lausch
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Apr 16, 2013 @ 1:13 pm
I have had three surgeries and I have permanent pain in my left knee, I didn't know I have a allograft which is recall. I called my old work comp lawyer now he won't help me to find specialist recall of allograft. Then next I called my doctor why I haven't been info about this. So it's been over 11 years from now. I'm scare to find out what result congenital disorder, bone tumor and spinal fusion. I need help. I've notice what bother me the most is it's alway failure in first time surgery arthroscopy showed that the literature had found there to be an overall three times higher failure rate. I guess I'm stuck with it and live it.
Sukh
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Jun 20, 2013 @ 1:01 am
I crushed my thumb and the bones haven't fused yet would grafting
Work for me or that bpm
Rebecca
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Jun 23, 2013 @ 2:14 pm
I have had 6 surgeries, 5 on my back L1 -L5, S1-S2 totally gone and then C4/5,C6/7,C7/8 done a week ago using bone graft from my hip on this one. I have degenerate Disc Disease, My first 3 Doctor's I became worst and was almost paralyzed, then I found Dr. Kenneth Burkus at the Hughston Clinic in Columbus, Ga. and he had to rebuild my back and spine completely. I am doing very goo now, I am still healing at 10 days out but getting better everyday. When I have to have another I will still use my Dr. who really cares about his patients. God Bless Ya'll
tyyah
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Sep 2, 2013 @ 1:01 am
I had knee surgery 5 days ago im n so much ain.I had
a bone graft. My anklefeels bowling ball is resting
On my foot.why would my ankle feel so bad
Top of the knee pain!! Can someone help is this normal??
AYO
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Sep 12, 2013 @ 5:05 am
My husband had bone fracture with loss of bone of about 3.5inches also with a massive wound which has taken over a year to heal due to presence of staphilococuss bacteria infection. the family is proposing a bone grafting which I had no idea of. kindly furnish me with details on bone grafting, where we can get is best done in india, health implication, possible duration of healing, cost implication and any other relevant information. the young man had been on crouches for over a year now. thanks.
kip
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Dec 16, 2013 @ 1:01 am
I have to do this on my arm its been 7 months and still no bone growth the doc is saying its the only way it will fix my arm any thing any one can tell me about it would help, I dont like docs or going under the knife but its about a 1/3 gap in my bone. did this work for any one and I will have my 4 year old son to deal with too, how bad is the pain will i need to be on pills?
Waqar
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Jan 25, 2014 @ 6:06 am
Dear i ve a fracture on my right femur and my bone is not joint with each other strongly.my doctor advise me for bone grafting.bone grafting procedure done with DCS plating and my question are following.

1.what is good thing or exercise to me after bone grafting.
2.how much time period required when I'll walked.
3.how much time required to heal.
4.can you give diet chart.

Note: i m smoker and 6 to 10 cigrate is my habit in a day.
Carol Munschauer
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Jun 22, 2014 @ 12:12 pm
My bone graft, hydroxyappetite is chipping away, has a pustule next to it and
I am in misery.
NOONE wILL intervene because NO ONE knows what to do if they run into hydroxyappetite while repeating a root canal or even trying to get tooth number out. I have suffered for 4 yearsbecssue no one agrees and they are all in political compteiton.
After 4 years of unhelped mouth infection I just got DIABETES.

Now my surgeon at Richmond Dental School and Blacksburg vA said he never operated on me though I have a letter to a lawyer sayig he did and all his hand written surgical note.
Who could I see anywhere in the uSA who could clean up my hydroxyappetite and repeat root canal that is leaking. Even taking tooth out. I have been told I am "a crock" more than once. How can I findout if my surgeon is certified in bone graftig which
ruined my life since 1989, I cannotkiss or bite a bagel.Worse they stick togeter circing their wagons and won't even see me orreturn my calls. Carol Munschauer PHD Buffaalo Ny
Ed
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Aug 16, 2014 @ 12:12 pm
Advice anyone please?
I have had an Osteotomy, bone graft surgery in Germany back in 1981 after a severe car accident, to correct the movement of the right hand. After all the pain and suffering, there was ZERO success. But the pains continue until today. The surgeon told me that pains will continue for the rest of life. I find this bizarre and difficult to understand.
Any one knows about ways to reduce or eliminate the continuous pains, apart from pain killers? I am 70 years old.
Thanks
Ed
Berlin
Germany

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