How knee replacement affects the planet

A total knee replacement can greatly improve a patient’s quality of life, but first the procedure itself will create nearly 30 pounds of waste, about half of which is biohazardous and requires energy-intensive treatment for disposal. safe.

Cataract surgery can provide a clear view, but only after releasing the equivalent of 181.8 kilograms of carbon dioxide, roughly the same as a car traveling 315 miles.

Although healthcare is one of the largest industries in the United States, its environmental impacts tend to go unnoticed: it accounts for 10% of the nation’s greenhouse gas emissions, and operating rooms generate 20 to 33% of total hospital waste. Researchers are just beginning to track and understand the environmental impacts of the sector.

Among these researchers, a team from the University of Pittsburgh whose work quantifies the effects of health care on the environment, and in this case relates specifically to a particularly waste-intensive and energy-intensive specialty: orthopedic surgery. Researchers from Pitt’s School of Medicine and Swanson School of Engineering reviewed the existing literature and found that while data is still sparse, efforts to reduce the carbon footprint of orthopedic surgery could have a huge impact .

“Surgical suites have a high environmental impact, in part because many of the items they rely on are single-use, disposable products, such as gowns, gloves, surgical instruments and packaging,” the company explained. -author Melissa Bilec, co-director of the Mascaro Center. for Sustainable Innovation and William Kepler Whiteford Professor of Civil and Environmental Engineering. “We are only just beginning to discover the impacts of the field, but we know the impacts are there. We also know that more research is needed to really define best practices for reducing environmental impacts, climate change and working towards a circular economy.

A circular economy focuses on reusing items and materials to keep them in circulation rather than relegating them to landfill at the end of their life cycle. Bilec leads an NSF-funded project that brings together an interdisciplinary team from five universities to use convergence research to address the complex challenge of global waste and create a circular economy.

Ian Engler and Andrew Curley, UPMC Orthopedic Surgery Sports Medicine Fellows and co-authors, were inspired to join this project after realizing the role their specialty plays in climate change – and the scant literature that is interested in it.

“While thousands of papers are published each year in the field of orthopedic surgery, very few address sustainability,” Engler said. “Given the immense impact of climate change, we believe that each area must consider its role in becoming more sustainable.”

“We wrote this review article to help the orthopedic field engage in recognizing and minimizing our impact on the planet,” Curley added.

In this review article, the researchers reviewed studies that assessed the impact of surgical procedures by performing a basic waste audit, where all waste is collected, sorted and weighed, or a life cycle analysis ( LCA) more complex, which quantifies the overall environmental impact of the resources used.

Some current interventions in orthopedic surgery include the use of anesthesia and low-emission manufacturing techniques, redesigning custom packaging, limiting single-use devices and materials, minimizing equipment in trays, proper separation of waste and recycling.

These changes can make a significant difference. For example, the authors note that awake hand surgery has recently been popularized as an alternative to sedative anesthesia. One study found that switching to this method, along with reducing the number of surgical supplies used for small procedures, resulted in a decrease of 2.8 tons of waste and over $13,000 in supplies.

Dr. Freddie Fu, posthumous co-author of the article, was instrumental in starting this project. Prior to his passing, Dr. Fu convened the team at his beloved UPMC sports complex to share his passion for understanding environmental impacts.

“I remember one of the last things Dr. Fu said to me: ‘I thought I knew everything about ACL surgery, now this team is going to teach me something new,'” Bilec said.

Engler and Curley recalled Dr. Fu’s enthusiasm for this study: “Dr. Fu immediately supported our passion for sustainability. He was ready to help in any way he could. For someone known for his boundless passion, that continued to define him throughout his final days.


  1. Ian D. Engler, Andrew J. Curley, Freddie H. Fu, Melissa M. Bilec. Environmental sustainability in orthopedic surgery. Journal of the American Academy of Orthopedic Surgeons, 2022; 30 (11): 504 DOI: 10.5435/JAAOS-D-21-01254
/Public release. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the author or authors.View Full here.

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