Sustainable Orthopaedic Systems

By Deborah Eastwood and Stephen Bendall

We cannot continue as we are. Today, not tomorrow, is the time to change. Change may begin with small unsteady footsteps but soon we will be walking and running to work differently, to deliver more but with greater thought, to be more careful and considerate in how we recruit and retain our colleagues, in how we train them and how we care for our environment. Whole system changes are required, but the first steps can and perhaps should start at ground level.

‘Sustainability’ in simple terms means the ability to maintain a process continuously over time.  We apply the term to our workforce where recruitment and retention of colleagues is essential and to our training practices, which need to move with the times. We also need to consider financial and social sustainability whilst recognising that environmental sustainability is of ever increasing global concern.

NHS England published ‘Delivering a net zero National Health Service’ in July last year: 4% of England’s total carbon footprint belongs to the NHS and our specialty accounts for 20% of that 4%. There is an onus for members of the BOA to sit up, take note and effect change.

The terms ‘carbon footprint’, ‘climate neutral’ and ‘net zero’ are widely used but their precise meaning is often less clear.

The carbon footprint is the net impact of a process or company in terms of its CO₂ emissions.

Climate neutral includes any carbon offsetting a company does.  Offsetting is where a company funds projects that lower or sequester CO₂, for instance planting trees, which could mean that they have only offset their emissions and not reduced them.

Net zero means cutting emissions to as low as possible which is clearly different and ‘greenwashing’ is the term applied when you are persuaded that a company is net zero when it is either actually at best climate neutral or at worse making false claims.

Although the goal of achieving a ‘net zero’ NHS by 2040 seems almost overwhelming, there are some areas where we as a group of clinicians can influence change. 

The broad principles we can follow are to reduce, reuse and recycle and we can all immediately see there are some easy gains and also some real challenges.

For instance, digital solutions which exploded during the COVID-19 pandemic allow remote patient consultations which then reduce patient travel and CO₂ emissions. Digital tools lead us onto the likely positive impact of machine-based learning (AI) on our practice. It is already making inroads into orthopaedic practice and we need to be proactive in monitoring its progress.

We have to challenge areas that have become embedded in our day-to-day practice and understand the carbon impact of what we do. Rizan et al’s paper gives an insight to cumulative carbon footprints for various surgical procedures which uniquely encompasses all the products including disposables used. The top carbon producing procedure was TKR: they noted that 54% of the total carbon footprint of the products used related to the use of single use items including drapes and gowns. How do we reduce the use and recycle these products? Whilst we are asking questions here are some more: do we always need energy hungry conventional laminar flow? Can we operate outside the theatre environment as the BSSH suggest? How many staff are required for a safe and effective surgical team?

So going forward what will the BOA do?
Our pledges are that:

• We will strive to embed sustainability into UK orthopaedic practice
• We will aim to include sustainability in the GMC T&O syllabus
• We will support the dissemination of knowledge and research in sustainability
• We will provide guidance on managing change in clinical practice driven by data gathering
• We will provide feedback on the impact of these measures

What ideas have you seen that work well and that we should consider too? Tell us about them.

What changes have you made in your department that might work in others too? Tell us how you did it.

What ideas have you got that may bring about wholesale change? Should we be promoting walking to work, more effective recycling of all aspects of our working day, working with other groups so that our power to change is multiplied, working on prevention at least as much as treatment?

Let us know how we should change, today.

Read more about sustainability in T&O in our dedicated section of the website at Sustainability in Orthopaedics.