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Examination: Harvesting and Implanting Allograft Bone
OCTOBER 1999, VOL 70, NO 4
Examination HARVESTING AND IMPLANTING ALLOGRApe BONE d. sciatic
1.The hip joint capsule is lined by an extensive membrane. This membrane is called a membrane. a. cutaneous b. synovial c. serous d. mucous
7.When donor femoral heads are opened during a surgical procedure, according to the article, they are first a. opened to air for 15 minutes. b. culture swabbed. c. placed in cold antibiotic solution to discourage bacterial growth. d. checked for tissue compatibility.
2.The main purpose of a bone bank is to provide allograft bone for surgical replacement and reconstruction. a. true b. false 3.Allograft bone is bone that is obtained from 1. relatives of the recipient. 2. cadavers 3. donor femoral heads. 4. people of the same blood and tissue type. a. 1 and2 b. 1 and 3 c. 2 and 3 d. 3 and4
8. During hip joint replacement surgery, wire mesh is used to a. remove the old cement. b. hold the acetabular cup in place. c. contain the impacted bone graft in larger defects. d. hold the cement in place. 9.It is not necessary to remove old bone cement and fibrous membrane in a total hip revision. a. true b. false
lo.
may be needed prophylactically during total hip replacements when osteolytic portions of the femur cortex are fragile, making them easy to fracture. a. Additional bone cement b. Titanium components c. Cerclage wiring d. Donor bone
&The hip joint is a ball and socket or joint. a. arthrodial b. enarthrodial c. pivotal d. condyloid 5.The hip joint is formed by the articulation of the and -. a. radius, carpals. b. articular, metacarpals. c. femoral head, acetabulum. d. acetabulum, condyloid. 6.The blood supply to the hip joint is supplied by the gluteal, femoral circumflex, and arteries. a. obturator b. common iliac c. femoral
11.Blood compatibility between the allograft bone donor and the recipient is necessary when the recipient is a. a pediatric patient with osteosarcoma. b. a geriatric patient with anemia. c. a rhesus negative woman of childbearing age. d. a rhesus positive woman of childbearing age.
1Z T h e hip joint is reinforced by the following ligaments. 1. anterior iliofemoral 2. inferior pubofemoral 672
AORN JOURNAL
OCTOBER 1999, VOL 70, NO 4
3. lateral collateral 4. spiraling posterior ischiofemoral 5. ligamentum teres a. 1, 2, 3, and 4 b. 1, 2, 3, and 5 c. 1, 2, 4, and 5 d. 2, 3,4, and 5
total hip revision surgery when previously implanted prostheses have failed. a. true b. false =All of the following provide nerve supply to the hip except the nerve. a. articular branches from the sacral plexus b. the great sciatic c. accessory obturator d. ischial
13.The actions of the hip joint are flexion, adduction, abduction, circumduction, rotation, and a. extension. b. gliding. c. circumabduction. d. circumadduction.
2l.Freezers used for bone bank storage must be capable of reaching temperatures of a. -65” C (-149” F) b. -75” C (-167”F) C. -85” C (-185” F) d. -95” C (-203” F)
1 A T h e hip joint is enclosed by a strong ligamentous joint capsule from the margin of the femoral neck above to the acetabulum below. a. true b. false 15.Cadaveric bone is usually procured at the end of a multiorgan retrieval. a. true b. false 16.Donor femoral heads are morselated during surgery for impaction in the surgical site. This means they are a. pounded in place. b. cut to size. c. fitted into the articulating spaces. d. minced in a bone mill. 17.The primary reason for prosthetic failure is thought to be accumulation of polyethylene debris and a. cement failure. b. aseptic loosening. c. prosthetic defects. d. patient noncompliance.
ra
occurs when the bony substance around the femoral stem and behind the acetabular cup component is lysed away. a. Osteoarthritis b. Osteoporosis c. Osteolysis d. Osteochondritis
19.Allograft bone is most frequently used during
=Often family members agree to allow the retrieval of body organs and soft tissue but are reluctant to donate bones because of fear of disfigurement. As a perioperative nurse, your most appropriate response to reassure the family members about bone donation would be a. “It is done all of the time.” b. “The surgeon will place appropriately sized rigid structures to retain the body’s shape.” c. “The surgeon will sew up the leg so you won’t know there has been anything taken out.” d. “You won’t be able to see that anything is missing.”
23.Mrs B’s femoral head was procured during her primary hip replacement surgery. Her blood culture results have come back positive for hepatitis B. As a perioperative nurse, you know that a. the bone can still be used but has to be processed in a special manner. b. the bone has to be soaked in antibiotics before it can be used. c. the bone cannot be used for donation. d. the bone must be stored at - 100” C (-212” F) if it is to be used. =During a total hip replacement, the surgeon roughens the existing acetabular bone bed. This is done to a. provide a base for the acetabular cup replacement. b. get rid of the existing cement. c. stimulate new bone growth.
673 AORN JOURNAL
OCTOBER 1999, VOL 70, NO 4
b. 1 and 3 c. 2 and 3 d.2and4
d. facilitate easier movement of the new acetabular cup replacement. =This ligament carries part of the blood supply to the femoral head. a. ligamentum inguinal b. ligamentum arcuate c. ligamentum ileopectineal d. ligamentum teres
31.The plug that is inserted into the distal femur acts as a for the impactors. a. driving pin b. centralizer c. measuring device d. femoral sound
=Allograft bone is most often used to reconstruct a. acetabular and femoral defects in total hip revision surgery. b. tibia1 and patellar defects caused by previous injuries. c. humoral defects that occur from traumatic injuries. d. cranial and mandibular defects. 27.0steolysis can be caused by all of the following except a. disease. b. ischemia. c. trauma. d. infection. =Strut grafts are used during surgery for a. reinforcement for weakened or fractured bone. b. morselization. c. fillers in place of bone cement. d. strengthening the acetabular cup components. 2S.Common reasons for failure of implanted prosthetic loosening are a. periprosthetic fractures. b. poorly developed prosthetic designs. c. poor surgical and cementing techniques. d. aseptic loosening. e. all of the above =During total hip revision surgery, the distal femur is occluded with a plug of 1. allograft bone. 2. cement. 3. titanium. 4. polyethylene. a. 1 and2
=One of the postoperative instructions for total hip replacement patients is that they are allowed to bend at the hip no more than a. 30" b. 45" c. 60" d. 90" =According to the article, some of the responsibilities of the bone bank coordinator are 1. supervising the bone harvesting. 2. packaging and documentation of all bone harvested. 3. checking the donor's laboratory reports. 4. issuing bone for use to private and public hospitals. 5. discarding bone that fails to meet donation criteria. a. 1, 2, and 3 b. 1,2, and 4 c. 2, 3, and 4 d. 2,4, and 5 e. all of the a b v e *According to the article, patients with impacted allograft bone are confined to bed rest for three to four weeks postoperatively. a. true b. false =.All of the following excludes patients from becoming potential bone donors except a. rheumatoid disease. b. autoimmune disease. c. communicable disease. d. basal cell carcinoma.
674 AORN JOURNAL
OCTOBER 1999, VOL 70, NO 4
Answer Sheet -NG
AND IMPLANTING ALLOGRAFT BONE
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 8023 1-5711 Or fax with credit card information to (303) 750-3212 Event #OW35
IDES Number
11
0000000000 0 0 0 0 0 0 0 0 0 0 (y 0000000000 0 ( i J @ @ @ @ @5@ ; @@ 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000
Session #5811
Program offered October 1999.
z
1
Session Number
The deadline for this program is Nov 30,2000.
0000000000 0000000000 0000000000 0000000000
1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination starting with question one. 3. A score of 70% correct is required for credit. 4. Record the time required to complete the program
Mark only one answer per question. 100000 200000 300000 400000 500000 600000 700000 800000 900000 1000000 1100000 1200000 1300000 1400000 I500000 1600000 1700000 1 8 0 0000 1900000
5. Enclose fee: Members $10; Nonmembers $20.
AORN (ID) # Name Address City State Zip RN license # State Phone number ( If nonmember, please provide Social Security number Fee enclosed or bill the credit card indicated Mastercard 0Visa 0American Express Card # Expiration date Signature (for credit card aurhonzarion)
675 AORN JOURNAL
2100000 22 0 0 0 00 2300000 24 00 000 2500000 2600000 2700000 2800000 2900000 3000000 3100000 32 0 0 0 0 0 3300000 3400000 3500000 3600000 37 00 0 00 38 0 0 00 0 3900000
OCTOBER 1999, VOL 70,NO 4
Learner Evaluation HARVESTING AND IMPLANTING ALLOGRAFe BONE
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. OBJECTIVES
Session Number
To what extent were the following objectives of this Home Study Program achieved? (1) Describe the use of allograft bone. ( 2 ) Identify sources of allograft bone. (3) Discuss the role of the perioperative nurse during the procurement of allograft bone.
cv
1
00@000000og 0000000000 0000000000 0000000000
PURWSWGOAL
(Low) (High) (Low) (High)
To provide information about harvesting and implanting allograft bone for the perioperative nurse. CONTENT
(4) Did this article increase your knowledge of the subject matter? (5) Was the content clear and organized? (6) Did this article facilitate learning? (7) Were your individual objectives met? (8) How well did the objectives relate to the overall purpose/goal? TEST QUESTIONS/ANSWUIS
(9) Were they reflective of the content? (10) Were they easy to understand? (11) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
~
Author names and addresses:
676 AORN JOURNAL
Examination HARVESTING AND IMPLANTING ALLOGRApe BONE d. sciatic
1.The hip joint capsule is lined by an extensive membrane. This membrane is called a membrane. a. cutaneous b. synovial c. serous d. mucous
7.When donor femoral heads are opened during a surgical procedure, according to the article, they are first a. opened to air for 15 minutes. b. culture swabbed. c. placed in cold antibiotic solution to discourage bacterial growth. d. checked for tissue compatibility.
2.The main purpose of a bone bank is to provide allograft bone for surgical replacement and reconstruction. a. true b. false 3.Allograft bone is bone that is obtained from 1. relatives of the recipient. 2. cadavers 3. donor femoral heads. 4. people of the same blood and tissue type. a. 1 and2 b. 1 and 3 c. 2 and 3 d. 3 and4
8. During hip joint replacement surgery, wire mesh is used to a. remove the old cement. b. hold the acetabular cup in place. c. contain the impacted bone graft in larger defects. d. hold the cement in place. 9.It is not necessary to remove old bone cement and fibrous membrane in a total hip revision. a. true b. false
lo.
may be needed prophylactically during total hip replacements when osteolytic portions of the femur cortex are fragile, making them easy to fracture. a. Additional bone cement b. Titanium components c. Cerclage wiring d. Donor bone
&The hip joint is a ball and socket or joint. a. arthrodial b. enarthrodial c. pivotal d. condyloid 5.The hip joint is formed by the articulation of the and -. a. radius, carpals. b. articular, metacarpals. c. femoral head, acetabulum. d. acetabulum, condyloid. 6.The blood supply to the hip joint is supplied by the gluteal, femoral circumflex, and arteries. a. obturator b. common iliac c. femoral
11.Blood compatibility between the allograft bone donor and the recipient is necessary when the recipient is a. a pediatric patient with osteosarcoma. b. a geriatric patient with anemia. c. a rhesus negative woman of childbearing age. d. a rhesus positive woman of childbearing age.
1Z T h e hip joint is reinforced by the following ligaments. 1. anterior iliofemoral 2. inferior pubofemoral 672
AORN JOURNAL
OCTOBER 1999, VOL 70, NO 4
3. lateral collateral 4. spiraling posterior ischiofemoral 5. ligamentum teres a. 1, 2, 3, and 4 b. 1, 2, 3, and 5 c. 1, 2, 4, and 5 d. 2, 3,4, and 5
total hip revision surgery when previously implanted prostheses have failed. a. true b. false =All of the following provide nerve supply to the hip except the nerve. a. articular branches from the sacral plexus b. the great sciatic c. accessory obturator d. ischial
13.The actions of the hip joint are flexion, adduction, abduction, circumduction, rotation, and a. extension. b. gliding. c. circumabduction. d. circumadduction.
2l.Freezers used for bone bank storage must be capable of reaching temperatures of a. -65” C (-149” F) b. -75” C (-167”F) C. -85” C (-185” F) d. -95” C (-203” F)
1 A T h e hip joint is enclosed by a strong ligamentous joint capsule from the margin of the femoral neck above to the acetabulum below. a. true b. false 15.Cadaveric bone is usually procured at the end of a multiorgan retrieval. a. true b. false 16.Donor femoral heads are morselated during surgery for impaction in the surgical site. This means they are a. pounded in place. b. cut to size. c. fitted into the articulating spaces. d. minced in a bone mill. 17.The primary reason for prosthetic failure is thought to be accumulation of polyethylene debris and a. cement failure. b. aseptic loosening. c. prosthetic defects. d. patient noncompliance.
ra
occurs when the bony substance around the femoral stem and behind the acetabular cup component is lysed away. a. Osteoarthritis b. Osteoporosis c. Osteolysis d. Osteochondritis
19.Allograft bone is most frequently used during
=Often family members agree to allow the retrieval of body organs and soft tissue but are reluctant to donate bones because of fear of disfigurement. As a perioperative nurse, your most appropriate response to reassure the family members about bone donation would be a. “It is done all of the time.” b. “The surgeon will place appropriately sized rigid structures to retain the body’s shape.” c. “The surgeon will sew up the leg so you won’t know there has been anything taken out.” d. “You won’t be able to see that anything is missing.”
23.Mrs B’s femoral head was procured during her primary hip replacement surgery. Her blood culture results have come back positive for hepatitis B. As a perioperative nurse, you know that a. the bone can still be used but has to be processed in a special manner. b. the bone has to be soaked in antibiotics before it can be used. c. the bone cannot be used for donation. d. the bone must be stored at - 100” C (-212” F) if it is to be used. =During a total hip replacement, the surgeon roughens the existing acetabular bone bed. This is done to a. provide a base for the acetabular cup replacement. b. get rid of the existing cement. c. stimulate new bone growth.
673 AORN JOURNAL
OCTOBER 1999, VOL 70, NO 4
b. 1 and 3 c. 2 and 3 d.2and4
d. facilitate easier movement of the new acetabular cup replacement. =This ligament carries part of the blood supply to the femoral head. a. ligamentum inguinal b. ligamentum arcuate c. ligamentum ileopectineal d. ligamentum teres
31.The plug that is inserted into the distal femur acts as a for the impactors. a. driving pin b. centralizer c. measuring device d. femoral sound
=Allograft bone is most often used to reconstruct a. acetabular and femoral defects in total hip revision surgery. b. tibia1 and patellar defects caused by previous injuries. c. humoral defects that occur from traumatic injuries. d. cranial and mandibular defects. 27.0steolysis can be caused by all of the following except a. disease. b. ischemia. c. trauma. d. infection. =Strut grafts are used during surgery for a. reinforcement for weakened or fractured bone. b. morselization. c. fillers in place of bone cement. d. strengthening the acetabular cup components. 2S.Common reasons for failure of implanted prosthetic loosening are a. periprosthetic fractures. b. poorly developed prosthetic designs. c. poor surgical and cementing techniques. d. aseptic loosening. e. all of the above =During total hip revision surgery, the distal femur is occluded with a plug of 1. allograft bone. 2. cement. 3. titanium. 4. polyethylene. a. 1 and2
=One of the postoperative instructions for total hip replacement patients is that they are allowed to bend at the hip no more than a. 30" b. 45" c. 60" d. 90" =According to the article, some of the responsibilities of the bone bank coordinator are 1. supervising the bone harvesting. 2. packaging and documentation of all bone harvested. 3. checking the donor's laboratory reports. 4. issuing bone for use to private and public hospitals. 5. discarding bone that fails to meet donation criteria. a. 1, 2, and 3 b. 1,2, and 4 c. 2, 3, and 4 d. 2,4, and 5 e. all of the a b v e *According to the article, patients with impacted allograft bone are confined to bed rest for three to four weeks postoperatively. a. true b. false =.All of the following excludes patients from becoming potential bone donors except a. rheumatoid disease. b. autoimmune disease. c. communicable disease. d. basal cell carcinoma.
674 AORN JOURNAL
OCTOBER 1999, VOL 70, NO 4
Answer Sheet -NG
AND IMPLANTING ALLOGRAFT BONE
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 8023 1-5711 Or fax with credit card information to (303) 750-3212 Event #OW35
IDES Number
11
0000000000 0 0 0 0 0 0 0 0 0 0 (y 0000000000 0 ( i J @ @ @ @ @5@ ; @@ 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000
Session #5811
Program offered October 1999.
z
1
Session Number
The deadline for this program is Nov 30,2000.
0000000000 0000000000 0000000000 0000000000
1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination starting with question one. 3. A score of 70% correct is required for credit. 4. Record the time required to complete the program
Mark only one answer per question. 100000 200000 300000 400000 500000 600000 700000 800000 900000 1000000 1100000 1200000 1300000 1400000 I500000 1600000 1700000 1 8 0 0000 1900000
5. Enclose fee: Members $10; Nonmembers $20.
AORN (ID) # Name Address City State Zip RN license # State Phone number ( If nonmember, please provide Social Security number Fee enclosed or bill the credit card indicated Mastercard 0Visa 0American Express Card # Expiration date Signature (for credit card aurhonzarion)
675 AORN JOURNAL
2100000 22 0 0 0 00 2300000 24 00 000 2500000 2600000 2700000 2800000 2900000 3000000 3100000 32 0 0 0 0 0 3300000 3400000 3500000 3600000 37 00 0 00 38 0 0 00 0 3900000
OCTOBER 1999, VOL 70,NO 4
Learner Evaluation HARVESTING AND IMPLANTING ALLOGRAFe BONE
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. OBJECTIVES
Session Number
To what extent were the following objectives of this Home Study Program achieved? (1) Describe the use of allograft bone. ( 2 ) Identify sources of allograft bone. (3) Discuss the role of the perioperative nurse during the procurement of allograft bone.
cv
1
00@000000og 0000000000 0000000000 0000000000
PURWSWGOAL
(Low) (High) (Low) (High)
To provide information about harvesting and implanting allograft bone for the perioperative nurse. CONTENT
(4) Did this article increase your knowledge of the subject matter? (5) Was the content clear and organized? (6) Did this article facilitate learning? (7) Were your individual objectives met? (8) How well did the objectives relate to the overall purpose/goal? TEST QUESTIONS/ANSWUIS
(9) Were they reflective of the content? (10) Were they easy to understand? (11) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
~
Author names and addresses:
676 AORN JOURNAL