Aims. In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery. Methods. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through EMBASE, Medline, and PubMed libraries using two domains of terms: “orthopaedic surgery” and “environmental sustainability”. Results. A total of 13 studies were included in the final analysis. All papers studied the environmental impact of orthopaedic surgery in one of three areas: waste management, resource consumption, and carbon emissions. Waste segregation was a prevalent issue and described by nine studies, with up to 74.4% of hazardous waste being generated. Of this, six studies reported recycling waste and up to 43.9% of waste per procedure was recyclable. Large joint arthroplasties generated the highest amount of recyclable waste per procedure. Three studies investigated carbon emissions from intraoperative consumables, sterilization methods, and through the use of telemedicine. One study investigated water wastage and demonstrated that simple changes to practice can reduce water consumption by up to 63%. The two most common barriers to implementing environmentally sustainable changes identified across the studies was a lack of appropriate infrastructure and lack of education and training. Conclusion. Environmental sustainability in orthopaedic surgery is a growing area with a wide potential for meaningful change. Further research to cumulatively study the carbon footprint of orthopaedic surgery and the wider impact of environmentally sustainable changes is necessary. Cite this article: Bone Jt Open 2022;3(8):628–640

Abstract. Introduction. The NHS generates 4–5% of the nation's total carbon emissions and over 500,000 tonnes of waste annually. Up to one-third of waste from orthopaedic procedures are recyclable, with large joint arthroplasties producing more than other subspecialties. However, there is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. This study aimed to analyse the environmental impact and sustainable initiatives undertaken within orthopaedic surgery. Methodology. A systematic review was performed according to PRISMA guidelines. The systematic search was conducted through EMBASE, Medline, and PubMed libraries. Results. Four studies analysed waste management in primary total knee replacements (TKRs) during the perioperative period. The most prevalent environmental issue was waste management. A total of 33 TKRs were observed across the studies. The mean waste generated per TKR was 13.1kg (range 11.6-15.1kg), with up to 69.9% being hazardous waste. The number of waste streams reported ranged from two to six. This study has further demonstrated that TKRs generated the highest amount of waste per procedure compared to other orthopaedic subspecialties. Three studies reported recycling waste, with up to 43% of total waste from TKRs being potentially recyclable material. Conclusion. Primary TKRs one of the largest contributors of waste generated by orthopaedic procedures during the perioperative period. Environmental sustainability in orthopaedic surgery is a growing area of interest with a wide potential for meaningful change. Further research is needed to study the cumulative carbon footprint of primary TKRs and long-term benefits of environmentally sustainable changes

Introduction: The volume of medical waste has increased in line with increasing medical, diagnostic and therapeutic procedures, and large joint arthroplasty is a major contributor. Demand for landfill sites due to increasing household, industrial and hospital waste loads, have made the current situation untenable. Methods: A prospective observational study of the waste from non contaminated packaging in consecutive joint replacements was undertaken. The total weight and volume of waste, the cost of disposal, and percentage and constituents of recyclable items were recorded for each case. Current costs and methods of local waste disposal were also investigated. Results: The average non-contaminated waste from a primary joint replacement is 5.2 kg and less than 1% is non-recyclable. Paper waste constitutes 57%, plastic waste 36%, cardboard waste 16% and metallic waste < 1%. Landfill costs are between £60–70 per tonne with recent and projected increases in landfill taxes. Revenue generated from recycling paper is between £50–80 per tone and plastic waste between £150–180 per tonne. Conclusions: Currently all potentially recyclable waste from common orthopaedic procedures is going to landfill. Reduce, Reuse and Recycle are the cornerstones of waste management. Medical organisations and staff need to understand how best to segregate waste and take advantage of opportunities for reuse and recycling. The introduction of a local or national recycling policy would make a definite impact on the environment, as well as potentially saving money

Waste disposal is an issue that affects us all. Medical waste disposal has posed even more difficulties with the appearance of needles, syringes, and other similar items on our beaches. The amount and toxicity of medical waste has increased in line with increasing medical facilities and diagnostic and therapeutic procedures. Demand for landfill sites and increasing household and hospital waste loads, have made the current situation untenable. New thinking and new strategies must be employed. There is significant waste production in the operating department during a primary total hip arthroplasty. A prospective observational study of the waste from packaging and non-clinical materials in consecutive total hip replacements was undertaken. The total weight and volume of waste, the cost of disposal and percentage of recycled items were recorded for each case. Inappropriate segregation of waste was recorded and the hazards involved are discussed. Reduce, Reuse and Recycle are the cornerstones of waste management. Medical staff need to understand how best to segregate waste and take advantage of opportunities for reuse and recycling. We must revisit the packaging of implants, the use of recycled paper. We did not inherit our environment from our parents; we are only minding it for our children

Waste disposal is an issue that affects us all. The amount and toxicity of medical waste has increased in line with increasing medical facilities and diagnostic and therapeutic procedures. Demand for landfill sites and increasing household and hospital waste loads, have made the current situation untenable. New thinking and new strategies must be employed. To investigate waste production in the operating department during a primary total hip arthroplasty. A prospective observational study, waste from packaging and non-clinical materials in fifty consecutive total hip replacements. Weight, volume, cost of disposal and percentage of recycled items were recorded. Inappropriate segregation of waste was recorded and the hazards involved are discussed. Domestic waste is compressed and buried at a cost of €222($383)/tonne. This extrapolates into a cost of about €1,500($2,589) yearly in the region and over €10,000($17,000) in Ireland. Cost to the environment, 2.6 tonnes locally, and 18.9 tonnes of surgical waste/year. Biological waste buried at €880 ($1,518)/tonne. Reduce, Reuse and Recycle are the cornerstones of waste management. Medical staff need to understand how best to segregate waste and take advantage of opportunities for reuse and recycling. We must revisit the packaging of implants, the use of recycled paper

Telehealth has the potential to change the way we approach patient care. From virtual consenting to reducing carbon emissions, costs, and waiting times, it is a powerful tool in our clinical armamentarium. There is mounting evidence that remote diagnostic evaluation and decision-making have reached an acceptable level of accuracy and can safely be adopted in orthopaedic surgery. Furthermore, patients’ and surgeons’ satisfaction with virtual appointments are comparable to in-person consultations. Challenges to the widespread use of telehealth should, however, be acknowledged and include the cost of installation, training, maintenance, and accessibility. It is also vital that clinicians are conscious of the medicolegal and ethical considerations surrounding the medium and adhere strictly to the relevant data protection legislation and storage framework. It remains to be seen how organizations harness the full spectrum of the technology to facilitate effective patient care.

Cite this article: Bone Joint J 2023;105-B(8):843–849.

Aims

This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices.