The environmental impact and sustainability of total hip and knee arthroplasty

Operating room waste is either disposed of in landfill sites, recycled, or undergoes costly, energy-intensive incineration processes. By assessing the quantity and recyclability of waste in primary hip (THA) and knee arthroplasty (TKA), we aim to identify strategies to improve sustainability. A prospective waste audit of 15 primary THA and 16 primary TKA cases was conducted at a tertiary orthopaedic hospital between April – July 2022. Waste was categorised into: non-hazardous, hazardous, recycling, sharps and linens. Each category was weighed. Items disposed as non-hazardous waste were catalogued for a sample of 10 TKA and 10 THA cases. Recyclability of items was determined using packaging. Average total waste generated for THA and TKA was 14.46kg and 17.16kg respectively. TKA generated significantly greater waste (p < 0.05). 5.4% of waste was recycled in TKA and just 2.9% in THA cases. Mean recycled waste was significantly greater in TKA cases compared to THA, 0.93kg and 0.42kg respectively. Hazardous waste made up the largest proportion for both TKA (69.2%) and THA (73.4%). Non-hazardous waste made up 15.1% and 11.3% of total waste for TKA and THA. In the non-hazardous waste, only two items (scrub-brush packaging and towel packaging) were recyclable. We estimate hip and knee arthroplasty generates over 2.7 million kg of waste in the UK annually. Currently, only a small percentage of waste is recycled in hip and knee arthroplasty, which could improve through increased use of recyclable plastics and clear labelling of items as recyclable by medical suppliers.