Bone Grafting

Overview

What is bone grafting?

This surgical procedure promotes your body’s natural bone-making process by:

  • Applying substances to gaps in weak, broken or deficient bones for added support.
  • Stimulating tissue growth to bridge gaps and restore bone strength and rigidity.

Who needs a bone graft?

This procedure may be necessary if bones don't heal correctly after a fracture. You may experience:

  • Delayed union: Bone healing (fusion) that occurs more slowly than expected.
  • Malunion: Bones that heal in an abnormal position.
  • Nonunion: When bone fusion does not occur.

Other reasons for a bone graft include:

  • Bone diseases like osteonecrosis and cancer.
  • Bone infection (osteomyelitis).
  • Congenital anomalies, such as uneven limbs or an abnormally small chin.
  • Jaw reinforcement (dental bone graft) before receiving a tooth implant.
  • Joint replacement surgery, which may require bone growth to secure an artificial joint.
  • Spinal fusion.
  • Trauma, including bad fractures that shatter bones.

Procedure Details

What type of bone graft might I need?

There are several bone grafting methods, including:

  • Allograft: This method uses bone tissue from another person (donor). Public health services have strict regulations on how tissues are handled and the bone tissue is cleaned and processed (sterilized) to ensure the safety of the recipient. This type of graft is common in spinal fusion surgery. It provides a framework around which healthy bone tissue can grow.
  • Autograft: An autograft uses a sample of your bone tissue. The tissue typically comes from the top of your hip bone (iliac crest). The surgeon makes an incision to obtain the bone tissue. The benefit of using your own tissue is that it increases the chances of successful fusion, but the amount of bone tissue that can be collected is limited. Additionally, you may have pain at the site where the bone graft is collected.
  • Bone marrow aspirate: Marrow is the spongy substance inside bones. It contains stem and progenitor cells that can help bone fractures heal. Using a needle, the surgeon gets a bone marrow sample from the hip bone (iliac crest). This bone marrow aspirate is used alone or mixed with other bone grafts to enhance bone healing for allograft procedures.
  • Synthetic bone graft: This type of graft uses artificially produced materials made from a variety of porous substances. Some also contain proteins that support bone development.

What happens during a bone grafting procedure?

During bone grafting surgery, here’s what to expect:

  • You receive anesthesia, medication that puts you to sleep and temporarily blocks sensation.
  • The surgeon makes an incision into the skin to access the bone that needs grafting.
  • They clean the bone and remove diseased tissue to prepare it for the graft.
  • The graft is applied and secured in place using different surgical techniques that might include hardware, such as plates or screws.
  • The surgeon uses stitches to close the incision.

Risks / Benefits

What are the risks of bone grafting?

All bone grafting procedures come with risks. They include:

  • Blood loss.
  • Infection.
  • Problems with bone healing.
  • Chronic pain.
  • Fractures.
  • Hardware failure, meaning plates and screws fail to hold the graft in place.
  • Scarring.

What are the benefits of bone grafting?

Benefits vary based on the grafting technique.

Autograft:

  • No risk of disease transmission.
  • Low chance of infection.
  • Bone-growing cells are in the graft, which increases the likelihood of successful bone healing.

Allograft:

  • No additional procedure is necessary to harvest bone tissue.
  • Low risk of spreading disease because bone tissue is sanitized.
  • Does not take tissue from other bones.

Synthetic bone graft:

  • Sterile, free of germs.
  • Available in unlimited quantities, so it can repair large sections of bone.
  • Many options exist, making it easier to meet a wide range of medical needs.

Recovery and Outlook

What happens after a bone grafting procedure?

Over time, the graft material grows into (fuses with) nearby bone tissue. This process can take anywhere from a several weeks or up to a year. The length of your recovery depends on the size and location of the bone graft. Other factors include your age and overall health status.

What is the outlook for people with bone grafts?

In most cases, bone grafts heal without complications. On rare occasions, recovery does not go as planned.

Issues may include:

  • Bone graft rejection.
  • Infection.
  • Nerve damage.

How can I lower my risk of complications?

Using tobacco can limit your healing potential. You can increase the likelihood of a successful recovery by quitting smoking and tobacco use.

When to Call the Doctor

When should I see my healthcare provider after a bone grafting procedure?

Contact your healthcare provider if you experience:

  • Bleeding, swelling or unusual drainage near the incision.
  • Fever.
  • Numbness or tingling (neuropathy) near the graft site.
  • Pain that does not respond to medications.

A note from Cleveland Clinic

A bone graft is a procedure to apply bone tissue or similar substances to damaged bones. There are many methods, including allograft, autograft and synthetic bone grafting. Your healthcare provider will select the option that’s right for you based on your health history and why you need a graft. It can sometimes take a while to recover from this procedure. But your new bones should stay strong and healthy for years to come.

Last reviewed by a Cleveland Clinic medical professional on 08/09/2021.

References

  • American Academy of Orthopaedic Surgeons. How Broken Bones Heal. (https://orthoinfo.aaos.org/en/recovery/fracture-healing-video/) Accessed 8/17/21.
  • American Academy of Orthopaedic Surgeons. Nonunions. (https://orthoinfo.aaos.org/en/diseases--conditions/nonunions/) Accessed 8/17/21.
  • Aitken G. Benefits and Associated Risks of Using Allograft, Autograft and Synthetic Bone Fusion Material for Patients and Service Providers - A Systematic Review. (https://journals.lww.com/jbisrir/fulltext/2010/08081/benefits_and_associated_risks_of_using_allograft,.18.aspx) JBI Library of Systematic Reviews. 2010;8(8):1-13.Accessed 8/17/21.
  • Beaman FD, Bancroft LW, Peterson JJ, et al. Imaging Characteristics of Bone Graft Materials. (https://pubs.rsna.org/doi/full/10.1148/rg.262055039) RadioGraphics. 2006;26(2):373-388. Accessed 8/17/21.
  • Lin K, VandenBerg J, Putnam S, Parks C, et al. Bone Marrow Aspirate Concentrate With Cancellous Allograft Versus Iliac Crest Bone Graft in the Treatment of Long Bone Nonunions. (https://journals.lww.com/otainternational/Fulltext/2019/03010/Bone_marrow_aspirate_concentrate_with_cancellous.2.aspx) J Orthopaedic Trauma. 2019;2(1):e012. Accessed 8/17/21.

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