BOA sponsored Chatterjee travelling fellowship

Omer Alanie

In the summer of 2022 I completed my Chatterjee Fellowship at the Istituto Ortopedico Rizolli in Bologna, Italy. During my visit, I was able to spend time with Professor Davide Donati and the rest of the tumour team who graciously welcomed me into the department. They are a supra-tertiary referral centre for tumours and complex reconstruction, receiving referrals from all of Italy and surrounding European countries for both tumour work as well as complex revision arthroplasty, and has a specialist interest in the use of bulky allograft for reconstruction, which is something that we do not see used commonly in the UK.

With co-visiting fellows in operating theatre

I was able to observe the use of bulk allograft in both the reconstruction of complex revision arthroplasty surgery and tumour reconstruction. It was predominantly utilised for pelvic reconstructions, proximal tibia and foot and ankle reconstructions. I saw its use in a number of cases, but what I found most fascinating is the number of cases of patients who had ‘returns to theatre’ following the use of bulk allograft for infection or other complications. It highlighted that this is not a benign treatment, and that the risks of infection in this patient cohort with this treatment was not negligible, and can be of similar magnitude to the use of other reconstruction options.

Case of a patient with a previous bulk allograft of pelvis, now unfortunately infected

It was very interesting discussing with the team there how they maintain their ability to provide such a service. This is because their ‘middle grades’ are on call for retrievals in a similar sense to a transplant retrieval team, and are on call for the entirety of Italy for this. This means that they can sometimes travel 5-6 hours to retrieve donor tissue which they can subsequently harvest and store for later use. This is something that perhaps is not feasible in the UK given the resource demands that such a service would require, but it was fascinating to see how they have established a network and retrieval team to allow provision of this service. Interestingly, the team felt the reason for lack of uptake of bulk allograft in the UK was predominantly due to concerns regarding prion transmission, rather than the logistical reasons. n