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RESEARCH ARTICLE
Contents Vol 48(6)

The carbon footprint of total knee replacements

Forbes McGain A B C * , Kasun Wickramarachchi D , Lu Aye E , Brandon G. Chan B , Nicole Sheridan B , Phong Tran F G and Scott McAlister A
+ Author Affiliations
- Author Affiliations

A Department of Critical Care, Medicine, Dentistry and Health Sciences, University of Melbourne, Vic, Australia.

B Department of Anaesthesia, Western Health, Melbourne, Vic, Australia.

C Department of Intensive Care, Western Health, Footscray, Melbourne, Vic 3011, Australia.

D Department of Anaesthesia and Perioperative Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia.

E Department of Infrastructure Engineering, University of Melbourne, Melbourne, Vic, Australia.

F Department of Orthopaedic Surgery, Western Health, Melbourne, Vic, Australia.

G Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Victoria University, St. Albans, Melbourne, Vic, Australia.

* Correspondence to: Forbes.mcgain@wh.org.au

Australian Health Review 48(6) 664-672 https://doi.org/10.1071/AH24154
Submitted: 27 May 2024  Accepted: 10 October 2024  Published: 29 October 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objective

Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation.

Methods

We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2e emissions, using Monte Carlo analyses with 95% confidence intervals.

Results

The average carbon footprint was 131.7 kg CO2e, (95% confidence interval: 117.7–148.5 kg CO2e); surgery was foremost (104/131.7 kg CO2e, 80%), with lesser contributions from anaesthesia (15.0/131.7 kg CO2e, 11%), and engineering (11.9/131.7 kg CO2e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7 kg CO2e, 33%), single-use equipment (34.2/131.7 kg CO2e, 26%), with polypropylene alone 13.7/131.7 kg CO2e (11%), and the knee prosthesis 19.6 kg CO2e (15%). For energy use, the main contributors were: gas heating (6.7 kg CO2e) and heating, cooling, and fans (4 kg CO2e).

Conclusions

The carbon footprint of a total knee replacement was equivalent to driving 914 km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation’s carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste.

Keywords: carbon footprint, circular economy, environmental footprint, healthcare sustainability, life cycle assessment, low value care, surgery, waste.

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