Creation of the bone bank of the Rabat and Casablanca region in Morocco

For a long time the use of bone grafting has demonstrated its interest in orthopedic surgery and traumatology. The autografts which are still very frequently used present various problems. On the one hand, it is necessary to find a correct mechanical quality and a sufficient quantity of bone. On the other hand, the graft removal lengthens the operative time and generally painful in postoperative. These disadvantages of autografts have led to the development of bone allografts. Indeed, the low immunogenic power of the bone, the good integration of the graft and the ease of bone preservation techniques make it possible to overcome the various problems posed by bone autografts. The increasing use of bone allografts has resulted in the need for a structure allowing the management of graft stocks. The purpose of this work is to demonstrate the mode of operation of a bone bank, whose conservation activity is limited to the femoral heads treated by cryopreservation and without secondary sterilization process. The bank collaborates with all orthopedic surgeons in the Rabat and Casablanca city at first and then with all orthopedic surgeons in Morocco. It provides allografts in quality and safety.


Perspective
The use of bone allografts has emerged in the face of the growing need for bone grafts in orthopedic surgery, traumatology and dental surgery. This need is not met by autografts which, despite their good results in terms of integration, pose the problem of comorbidity. Xenografts are avoided due to the risk of transmission of spongiform infection, while the remaining bone substitutes, which remain the most available, still pose the problem of toxicity and biocompatibility [1,2]. Biologically, allografts are considered to be excellent transplant material as immune reactions have only a secondary clinical role, with rare cases of rejection. The bone bank is defined as a service of a State-accredited public health institution that takes care of the collection, collection, securing, distribution and traceability of bone allografts. Bone allografts are of two types: femoral heads taken from a living donor during hip arthroplasty, or massive bone segments from deceased donors [3]. It also makes it possible to profit from an organ amputated from the body because of illness provided that it does not make it into a commercial transaction object.
Organizational and technical aspects: Our project consists in realizing a bone bank whose conservation activity is restricted for technical and legal reasons to the femoral heads taken from a living donor and treated by cryopreservation without a secondary sterilization process, knowing that the femoral heads presently constitute in our context, the allograft that is the easiest to obtain, The choice of cryopreservation comes from financial as well as technical requirements; cryopreservation is cheaper than freezedrying, but it is also a more feasible process for staff, with better Page number not for citation purposes 3 bone quality. Similarly, the choice of the "no touch" option of not performing secondary sterilization is due to the fact that irradiation, which remains the best sterilization process, impairs the mechanical properties of the graft while the cryopreserved femoral heads, without secondary sterilization have demonstrated their reliability in terms of health safety, provided that they comply with the aseptic measures during sampling, perform a selection of donors and respect the quarantine period [6][7][8][9]. The safety of the grafts thus passes through an anamnestic, clinical and biological screening. Subsequently, as soon as the stocks and the implementation of the procedures allow, the bank will be able to supply the entire Moroccan kingdom. In order to judge the feasibility of the project, an approach of orthopedic surgeons was established. Our survey was carried out among 100 orthopedic surgeons throughout the kingdom, 80 of them from the Rabat and Casablanca region. The opinion survey concluded that the project was beneficial, with a need for allografting in trauma, then in tumor surgery and in 3 rd place during revision of arthroplasty. The orthopedic surgeons contacted said they were ready to collaborate with the Rabat bank and to supply it. The approach of patient's candidates for hip arthroplasty has also been carried out to judge the patients' adhesion to the donation of their femoral head. It should be remembered that the sampling, even if it is a surgical residue, does not can be achieved without the informed consent of the patient.
We surveyed 60 patients who were candidates for hip arthroplasty: 90% of the patients said they were in favour of the donation and were ready to perform the serological tests.

Conclusion
The bone bank project is part of a therapeutic need due to the growing need for bone allografts in trauma, oncology and arthroplasty. The choice of a femoral head bank is currently the most accessible in our context, both financially and legally. The femoral heads will allow orthopedic surgeons to improve their practice and expand their therapeutic arsenal by offering more conservative treatments and limiting the flow of patients abroad for costly care.

Competing interests
The authors declare no competing interest.

Authors' contributions
All the authors have read and agreed to the final manuscript.