Bone cement in total hip arthroplasty - Is it really green?

Background: Total hip replacement (THR)is typically cemented, cementless or hybrid depending on patient factors and surgeon preference. To date no studies have evaluated waste generated with each of these procedures in relation to implant choice, and particularly waste related to consumables. We aimed to quantify the volume; type and ability to recycle this waste and suggest potential strategies for reducing the overall waste related to consumables in THR.

Method: This was a prospective review of all waste related to consumables in THR. The waste was weighed using a Salter 1066 BKDR15 scale, accurate to the nearest 1 ​g. The primary outcome was the amount of waste generated per case depending on implant choice (cemented vs. uncemented). Secondary outcomes included: proportion of clinical waste and proportion of recyclable waste.

Results: Cemented THR generated a total of 1.89 ​kg of waste compared to 775 ​g for an uncemented THR. Cemented THR generated significantly more sterile (hazardous) waste than uncemented THR both as overall volume and as a proportion 763 ​g (40%) vs 76 ​g (10%). Significantly more of the waste related to uncemented THR was amenable to being recycled through conventional waste streams with simple changes in theatre 672 ​g (86%) compared to 989 ​g (52%) with cemented THR. Between 20 and 30% of waste packaging for both types of surgery compromised information booklets.

Conclusion: Cemented hip replacement generates significantly more waste from consumables than uncemented and a greater amount of this waste is hazardous requiring intensive processing. For both implants a significant proportion of waste can be recycled with simple process changes in theatre. Industry partners have a responsibility to minimise unnecessary packaging and work with surgeons to improve sustainability.