Sustainability in Orthopaedics

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.