Australian Cerebral Palsy Musculoskeletal Health Network: Bone Quality in Children with Cerebral Palsy

Transiliac bone biopsy Lay description: What is a Transiliac Bone Biopsy? A transiliac bone biopsy is when a small piece of bone is taken from the hip so that it can be looked at under a microscope. Why does the doctor want to do a Transiliac Bone Biopsy? If it has been suggested that a transiliac bone biopsy be done then your child has a significant bone problem. Where possible, the cause of the bone problem and the best way of treating it will be worked out by using other investigations such as x-ray and blood tests. If, when all usual tests are done it is still unclear what is wrong with your child’s bones, or to make sure that treatment is going to plan, a transiliac bone biopsy may be needed. In these situations the best way to find out what is wrong with the bone is to get a bit of it and look at it under a microscope. What does having a Transiliac Bone Biopsy involve? A transiliac bone biopsy involves having minor surgery where a small piece of bone is taken from the hip. This is done at The Children’s Hospital at Westmead under a general anaesthetic. Before the biopsy: On days 17, 16, 5 and 4 before the biopsy it is very important that the antibiotic Demeclocycline is taken twice a day as outlined on the Labelling Sheet. This medication is taken to give information on the way bone is made. If the medication is not taken as recommended, the biopsy is less useful. Day of the biopsy: On the day of the transiliac bone biopsy your child will come to Middleton Ward of the Children’s Hospital at Westmead by 8am. Your child should be fasting i.e. nothing to eat or drink from 12 midnight the night before. Your child will be seen by an anaesthetist who will make sure that he/she is well. If your child is unwell on the day before or the morning of the biopsy, please phone Dr Craig Munns (02) 9845-3200. When it is time for the biopsy to occur, your child will be taken into the operating room. They will be put to sleep either by breathing gas or having an IV cannula put into a vein and medication given. Once asleep, a small cut (2 cm) will be made in the skin at the top of the hip and a small piece of bone (5 – 7 mm or the size of the top of a pen) will be taken. The skin will be stitched using 2 – 3 dissolvable stitches. A large bandaid will be placed over the stitches. After the biopsy: Your child will have to lay flat for 3 hours after the biopsy to make it less likely that bleeding will occur. After 3 hours your child will be able to go home as long as they are able to eat. The area where the biopsy was taken from should be kept dry for 48 hours. Panadol is usually all that is needed to control pain. If any stitches have not dissolved and come out after 10 days they will need to be removed by your local doctor. What are the possible complications of a Transiliac Bone Biopsy? A transiliac bone biopsy is a relatively safe procedure. The three possible side effects are: 1. Bleeding – the chances of this occurring are decreased by the doctor putting pressure on the biopsy area at the time the biopsy is taken, and by your child laying flat for 3 hours after the biopsy is done. 2. Infection – the chance of the wound getting infected is decreased by the doctor using a ‘sterile technique’ to take the biopsy, and by keeping the area dry for 48 hours after the biopsy. 3. Pain at the site of the biopsy – this is usually mild and decreased by using Panadol. Almost all children are able to do their normal activities the day after the biopsy is taken. There is a small risk associated with any anaesthetic. The risk is less if the anaesthetic is given when your child is well. This means we will not do the biopsy if your child is sick and will rebook it for a time when he / she is well. When will we know the result of the Transiliac Bone Biopsy? Because of the complexity of analysing the biopsy and because it has to be sent to Canada for analysis, it can take 4 – 6 months to get the full result. In certain situations a result can be available earlier. Biopsy will be performed by Prof Munns Biopsy will be undertaken at Queensland Children's Hospital (Prof Munns). Analysis will occur at Queensland Institute of Technology (Prof Peter Pivonka) Each while (n=30) will have only one biopsy performed undertaken at the same time the child is having their scheduled hip surgery. The biopsy is done under a general anaesthetic. The information is for research purposes only. It will not influence treatment. The work at QUT will be done under strict quality control conditions. Dosage of Demeclocycline: 15-20 mg/kg/day (Maximum: 900 mg/day). Demeclocycline is available in 150 mg capsules to be taken orally. Demeclocycline taken in two divided doses 17, 16, 5 and 4 days before planned date of biopsy.