Antimicrobial implants and bone allografts: new uses for old antibiotics

Bone grafting is the procedure whereby missing bone is replaced with material from either the patient’s own body (autograft), that of a donor (allograft) or with synthetics. The use of exogenous materials to reconstruct skeletal defects is not a new concept. Artificial, synthetic or natural substitutes, in the form of gold and silver plates and pieces of coconut shell, were found in cranial defects within prehistoric skulls [1]. As a matter of fact, bone was the second-ever transplanted tissue, with tooth being the first. While it is possible that these procedures were performed even earlier, the first documented bone transplantation was performed in 1668 by the Dutch surgeon Job van Meek’ren, who described the filling of a bony defect in a soldier’s cranium with a piece of skull from a dog [2, 3]. In 1879, some two hundred years later, Sir William MacEwen introduced allografting in a 4-year-old boy when he successfully replaced the proximal two thirds of a humerus with bone procured from other patients [4]. In 1915, Fred Albee, MD described autologous bone grafting where he used part of a patient’s tibia for spinal fusion. Bone grafting continues to be used extensively in medicine today. Even though the basic principles of bone transplantation have not changed significantly, the materials and techniques used have evolved tremendously. Multiple bone substitutes have been characterized over the last 50 years, the unique fibrous and mineral composite nature of bone is difficult to recreate, making bone allograft the most successful substitute.