Introduction: Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Slooff et al. (1996) reported the use of cancellous graft alone. Brewster et al. (1999) morselised the whole femoral head after removal of articular cartilage. This paper asks, is it really necessary to use pure cancellous graft?

Methods: 42 acetabular revisions using impacted morselised bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow up was 2.6 years (1–5yrs). Clinical and radiographic assessment was made using the Oxford Hip score, Hodgkinson’s criteria (1988) for socket loosening and Gie classification (1993) for evaluation of allograft consolidation and remodelling.

Results: 40(95%) sockets were considered radiologically stable (Type 0, 1, 2 demarcations). 2(5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. 27(64%) cases showed good trabecular remodelling (grade 3). 12(29%) cases showed trabecular incorporation (grade 2). Only 3(7%) cases showed poor allograft incorporation (grade 1). Average pre operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 2.6 years.

Conclusion: Early radiological and clinical survival results with retaining articular cartilage of femoral head allograft are similar and comparable to other major studies for acetabular impaction bone grafting in revisions. Minimal loss of allograft mass is 40% in obtaining pure cancellous graft. When there is a limited supply and demand of allograft, saving up to 40 % of the material is a valuable and cost effective use of scarce resources.

Introduction: Radiation dose exposure to patients in a main X-ray department in a hospital is well documented and controlled. Few studies report the radiation exposure to patients undergoing spinal surgery received from an image intensifier. There are no recommended doses published when using the image intensifier

Methods: We reviewed the radiation doses and exposure times from computer and radiation log records of all the patients who underwent trauma & orthopaedic surgery which required an image intensifier between January and September 2005. The Dose-Area-Product (Gray/cm2) and screening time was recorded.

Results: More than 600 patients underwent trauma & orthopaedic surgery that required an image intensifier at the time of surgery. The mean screening Dose Area Product of the patients undergoing spinal surgery and other common procedures are shown (Gray/cm2):- Lumbar fusion – 23. Disc replacement – 10. Discogram – 4.9. Foraminal injection – 4.4. DHS – 1.86. IMHS – 1.33. ORIF Ankle – 0.89. MUA k-wire wrist – 0.04. The four surgical procedures which required the most radiation were spinal procedures. The maximum radiation is given to patients undergoing lumbar spinal fusion.

Conclusion: Patients undergoing spinal surgery can receive as much radiation exposure as those undergoing procedures such as barium swallow or standard lumbar spine films. Efforts should be made to reduce radiation exposure to orthopaedic patients, and operating surgeons especially those undergoing spinal surgery. By publishing our radiation exposure doses, we can begin to establish guidelines for recommended patient doses.