Ethylene Oxide (ETO)

One other common method of terminal sterilization, often used as alternative for gamma irradiation, is ethylene oxide treatment. There is controversy regarding the suitability of ethylene oxide sterilization for bone grafts,⁵⁸ with some authors arguing that it damages the osteoinductive potential of the graft,^{59, 60} while others state that it does not.^{61, 62} Ethylene oxide is also potentially carcinogenic and residual gas can cause inflammatory reaction in the recipient. A medium term follow up of ethylene oxide sterilized freeze-dried allograft in acetabular revision only reported one revision for aseptic loosening in 21 cases at a mean 5.8 years, although 62% did show significant acetabular component migration.⁶³