The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs

Arthur P Drouaud; Peggy E Miller; John M O'Byrne

doi:10.1016/j.surge.2024.04.007

The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs

Surgeon. 2024 May 8:S1479-666X(24)00039-8. doi: 10.1016/j.surge.2024.04.007. Online ahead of print.

Authors

Arthur P Drouaud¹, Peggy E Miller², John M O'Byrne³

Affiliations

¹ The George Washington University School of Medicine and Health Sciences, 2300 I St., NW, Washington, D.C., 20037, USA. Electronic address: arthurdrouaud@gwu.edu.
² National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas, Dublin 11, Ireland. Electronic address: PeggyMiller@rcsi.ie.
³ National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas, Dublin 11, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. Electronic address: jmobyrne@rcsi.ie.

PMID: 38724298
DOI: 10.1016/j.surge.2024.04.007

Abstract

Background and purpose: The rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices.

Methods: The study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO₂e) and disposal costs were calculated.

Results: In a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 kgCO₂e per case, revision hips 23.50 kgCO₂e, primary knees 15.82 kgCO₂e, and primary hips 14.64 kgCO₂e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO₂e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed.

Conclusion: The research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.

Keywords: Carbon emissions; Disposal costs; Environmental impact; Joint arthroplasty; Total hip replacement; Total knee replacement.