Presentation (CTI)

OBJECTIVES: Healthcare contributes 5% of global greenhouse gas emissions. Health systems increasingly recognise the importance of sustainability. Total knee replacement (TKR) is a common procedure and prosthetic joint infection (PJI) is a debilitating complication. We sought to establish the environmental impact (EI) of TKR care pathways and subsequent PJI.
METHODS: Patients undergoing TKR were identified from Hospital Episode Statistics in England between 01/Apr/2023 and 31/Mar/2024. We identified PJI within three years. The TKR pathway was developed using Sustainable Health Coalition (SHC) guidance. Surgery duration was assigned 105 mins for TKR and reoperations. EI of reoperations, readmissions, outpatient appointments (OPA), and imaging was calculated as carbon (CO₂ equivalent), water, and waste impact using 2023 SHC values.
RESULTS: 75,125 patients (57% female; mean age 69 years) underwent 75,285 TKRs. Within 2 years, 98% attended orthopaedic or physiotherapy OPAs; 23% had X-ray, 14% CT, and 6% MRI. 10,915 (15%) patients had 1.4 readmissions per person [pp] within 3 months and 475 (<1%) underwent 1.2 reoperations pp within 24 months. 965 (1.3%) had PJI; 98% were readmitted, 34% reoperated, and 6.2% required 1.3 ICU admissions pp. Estimated EI for a representative person undergoing TKR was 404 kgCO₂e, 337 m³ water, and 13 kg waste; of which TKR surgery accounted for 45%, 83% and 77%, respectively. A patient with PJI would have an additional 1,905 kgCO₂e, 3,054 m³ water, and 166 kg waste pp.
CONCLUSIONS: EI associated with TKR care pathway is equivalent to the carbon for driving 2,200 km, 4,200 bathtubs of water, and a packed suitcase of waste pp. PJI leads to an additional 10,500 km, 1.2 Olympic pools of water pp. These figures are likely underestimated as only imaging with knee codes was included, there were no water and waste values for OPAs, and no EI values were available for medical cement.