Ecological Burden of Modern Surgery: An Analysis of Total Knee Replacement's Life Cycle

• Delaie Camille
• Cerlier Alexandre
• Argenson Jean-Noel
• Escudier Jean-Charles
• Khakha Raghbir
• Flecher Xavier
• Jacquet Christophe
• Ollivier Matthieu

• Total knee replacement
• Carbon footprint
• Life cycle

Background: It is estimated that surgical procedures account for 20%-30% of the greenhouse gases emissions from health-care systems. Total knee replacements (TKR) are one of the most frequently performed procedures in orthopaedics. The aim of this study was to identify and quantify the environmental impacts generated by TKRs, the factors that generate the most emissions, and those that can be easily modified. Methods: To calculate the life cycle carbon footprint of a posterior stabilized cemented TKR performed in a single orthopaedic surgery department, 17 TKRs performed between October 12 and 20, 2020 by 4 senior surgeons were analysed. The analysis of the life cycle included the manufacture of the implant, from raw materials to distribution; the journey made by patients and staff; and the surgery including all consumables required to facilitate the procedure. Results: The overall life cycle carbon footprint of a single TKR was 190.5 kg of CO 2. This consisted of 53.7 kg CO 2 (28%) for the manufacture of the prosthesis, 50.9 kg CO 2 (27%) for travel, 57.1 kg CO 2 (30%) for surgery, and 28.8 kg CO 2 (15%) for waste management. This is comparable to a New York-Detroit direct flight. Conclusions: The production of a total knee prosthesis, throughout its life cycle, generates emissions with important consequences on the environment and therefore on our health. Although much data are currently missing to make precise estimates, and especially regarding benefits in terms of patient function and its impact on carbon emissions, these data serve as a starting point for other more detailed or comparative studies.