Autograft (patient's own bone): most commonly harvested from the iliac crest (pelvis). An incision is made over the pelvic brim and bone is taken using a gouge or trephine. Alternatively, local bone from the surgical site, the Reamer-Irrigator-Aspirator (RIA), or distal radius may be used. Allograft (donor bone): obtained from a tissue bank, available as chips, struts, or freeze-dried powder. Synthetic: bone substitutes such as tricalcium phosphate, hydroxyapatite, or bone morphogenetic protein (BMP). The graft is placed at the target site — fracture non-union, fusion bed, or bone defect.
Bone grafting is used for fracture non-unions, spinal fusion, filling bone defects after tumour surgery, arthrodesis procedures, and revision arthroplasty with bone loss.
For non-unions: bone stimulators (electromagnetic, ultrasound), PRP/stem cell injections (limited evidence). For bone defects: some defects heal by secondary intention with time.
Assessment of the graft requirement (volume, structural vs. cancellous). If autograft, the iliac crest harvest site is planned. If allograft, the graft is sourced from a tissue bank.
Autograft is the gold standard — it provides living bone cells (osteogenesis), a scaffold for new bone growth (osteoconduction), and growth factors that stimulate bone formation (osteoinduction). Union rates for autograft-augmented non-unions are approximately 85–95%.
Donor site painCommon
Iliac crest harvest site pain is the most common complaint. Affects 10–30% of patients and may persist for months.
Donor site haematomaCommon
Bleeding at the harvest site.
NumbnessUncommon
Lateral femoral cutaneous nerve injury causing thigh numbness from iliac crest harvest.
Donor site fractureRare
Iliac crest fracture after harvest. Very rare.
Pelvic instabilityRare
If too much bone is taken. Very rare.
InfectionUncommon
At the harvest or recipient site.
Graft resorptionUncommon
Allograft or synthetic graft may be resorbed before incorporation.
Disease transmissionRare
Extremely rare with modern allograft screening.
HerniaRare
Through the iliac crest defect. Very rare.
General or regional anaesthesia. The harvest site adds a second surgical field.
The iliac crest harvest site is sore for two to six weeks. Walking is permitted immediately. The recovery from the primary procedure (non-union surgery, fusion, etc.) determines the overall rehabilitation timeline.
Follow-up is determined by the primary procedure. The graft incorporation is monitored with X-rays.
Why is autograft better than allograft?
Autograft is living bone with cells, scaffold, and growth factors — the gold standard. Allograft provides scaffold but no living cells. Synthetic substitutes provide scaffold only. Autograft has the highest healing rates but requires a second surgical site.
Can bone be harvested from somewhere other than the pelvis?
Yes. Local bone from the surgical site, the RIA system (which harvests bone from the femoral canal), and the distal radius are alternatives. The iliac crest remains the most commonly used and reliable source.