The Use of bone allograft in orthopaedic Surgery has been predicted to increase particularly in joint revision surgery. This has led to a potential problem with supply. Questionnaires were distributed to all 146 Consultant orthopaedic Surgeons working in Scotland in 2000. They were asked to indicate their current usage of bone and tissue allograft, any problems encountered with supply and if alternatives to allograft such as processed bone, might be used. The questions asked were very similar to those asked in a survey by the author (GG) in 1995 to enable comparisons to be made. 74% of all bone issued by the SNBTS in 2000 –2001 was used in revision hip arthroplasy. This compares with only 66% of bone issued in 1998–1999.

Replies were received from 125 consultants (87%) of whom 93 reported using bone allograft. 41 consultants (46%) predicted an increase in their requirement for bone allograft, and 23 (26%) felt they could currently use more bone if this became available. Sixty percent of Surgeons would consider using processed bone as an alternative. In comparison with figures from a previous study in 1995, an increasing number of surgeons are prepared to use processed bone as an alternative to fresh frozen allograft. As the number of revision THR’ s continues to increase the amount of bone required is likely to continue to increase. The need to increase efficiency in harvest and supply of bone is therefore great. The use of more SNBTS nurses in selection of patients and collection of bone may increase efficiency. More surgeons may have to use processed bone, which would allow more bone to be released. Also processing may help reduce transmission of infective particles such as HIV and new variant CJD. With rising public and medical concerns over these issues this seems most desirable.

The Scottish National Blood Transfusion Service is the main provider of bone for grafting in Scotland. Bone is procured only from live donors, following very strict selection criteria, and we have investigated whether the amount being collected was adequate.

Our current harvest of approximately 1700 femoral heads per year is shown not to be enough to meet the future demand for revision surgery of the hip. Many more of these operations are being undertaken, and impaction grafting is being used increasingly.

We have calculated the predicted rates of collection and usage for the next four to five years so that we can expand our service in a controlled fashion.