Introduction Ionising radiation is a constant risk to exposed workers. Recently, it was shown that the incidence of malignant diseases was increased in an orthopaedic hospital among exposed personnel. However, the surgeons are often ill-informed about the utilisation of the fluoroscopic units, which leads to unnecessary exposure to radiation, for both the operating team as well as the patients. This review article aims to give a comprehensive review on the exposure of staff in the orthopaedic operation room and to develop advises to reduce the risk deriving from ionising radiation. Material and methods A comprehensive review of the published literature associated to intra-operative radiation in orthopaedics was performed. The electronic platform, PubMed was used to search for relevant studies. The keywords used included 'intra-operative radiation', 'radiation orthopaedics' and 'radiation'. The search was performed in English and German. The reference list of identified articles was crosschecked to identify further articles that contributed to the topic. Results Using the above mentioned inclusion criteria, 30 articles were identified that contributed to the topic. Intraoperative fluoroscopy increases the radiation dose distinctly. Especially, the scatter radiation leads to increasing doses for the surgical team. Scatter radiation occurs while passing through the patient's body. Only 2% of the emitted photons actually reach the image intensifier. On the contrary, 10%-20% of the photons are scattered. Conclusion Intra-operative fluoroscopy is a precious and essential tool for orthopaedic operations. If the surgical staff follow the principles (shielding, ALARA, etc.), the radiation exposure in the operating room can be reduced significantly. New technologies will hopefully help in the future to further reduce the emission of radiation.