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.J Bone Joint Surg [Br] 1998;80-B:595-9. Received 8 April 1997; Accepted after revision 9 December 1997 Small bone allografts are collected, tested, 'fresh frozen' and distributed by the five regional transfusion centres of the Scottish National Blood Transfusion Service (SNBTS) based in Glasgow, Edinburgh, Dundee, Aberdeen and Inverness.All these regions collect femoral head allografts from patients undergoing elective primary total hip replacement (THR), most with a diagnosis of osteoarthritis (OA). Some regions also collect tibial plateaux, but these are a small proportion of the total. Bone is not collected from patients with fractured neck of the femur or rheumatoid arthritis, or from cadavers or multi-organ donors.Collected bone is tested for mandatory viral markers and bacteriological infection. If these tests are negative it is frozen and quarantined for six months. The donor is then retested for the viral markers and, if these tests are clear, the bone is released for use. When a bacteriological infection is found, bone does not have to be discarded but can be processed further. This occurs in 10% to 15% of all available bone.Small bone allografts are used in a number of orthopaedic operations such as spinal fusion and in trauma, but particularly in revision of THR. We investigated the available supply of fresh-frozen bone allografts from live donors in Scotland, and attempted to predict the total demand for their use in revision THRs. Materials and MethodsSupply of fresh-frozen bone allografts. The overall availability of such allografts from live donors can be calculated by estimating the rates of primary elective THR for OA. The annual Standard Morbidity Records (SMR 1), as coded by the Office of Population Censuses and Surveys (OPCS), for primary THR in Scottish hospitals from 1989 to 1994, were studied 1 and the number of primary elective replacements calculated as described by Williams et al. 2,3 This was compared with the SNBTS 4 information on the number of potential bone donors in order to check the accuracy of coding in each hospital and to indicate whether the SNBTS was collecting bone from all available patients. Although the numbers are relatively small they were considered to be adequate to provide relatively crude predicted rates. Once we had shown that the SMR 1 figures were relatively accurate, estimates of the number of operations e...

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.