SynthesisInternational orthopaedics2026
Quantifying the environmental footprint of primary hip and knee arthroplasty: a systematic review and pooled-analysis of waste generation and carbon emissions.
Synthesis in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOperating rooms contribute disproportionately to healthcare-related greenhouse gas emissions and waste generation. Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are high-volume procedures with increasing global incidence, yet pooled data on their environmental impact are lacking.
methodsA systematic review and pooled analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261297449). PubMed, Embase, and Scopus were searched through October 31, 2025, for studies reporting total waste, recyclable waste, and carbon dioxide equivalent (CO₂e) emissions associated with primary THA and TKA. Seventeen studies, including 394 procedures, were included. Data extraction covered waste quantity, recyclable proportion, and carbon footprint. Random-effects models with inverse variance weighting were used to calculate pooled mean estimates. Standard deviations were estimated from reported ranges when not provided. Heterogeneity was assessed using I
resultsPooled mean total waste per arthroplasty was 12.27 kg (95% CI, 10.88-13.66). Recyclable waste averaged 1.97 kg per procedure (95% CI, 1.64-2.31), representing 14.5% of total waste (95% CI, 11.99-17.02), and indicating substantial unrealized recycling potential. Carbon footprint estimates varied substantially by accounting methodology. Studies measuring waste-disposal emissions alone reported a pooled mean of 13.7 kg CO₂e per case (95% CI, 11.32-16.08), whereas comprehensive life-cycle assessment (LCA) studies reported a pooled mean of 135.37 kg CO₂e per case (95% CI, 74.91-195.83). Considerable inter-study heterogeneity reflected differences in waste segregation, recycling infrastructure, and carbon accounting methodologies.
conclusionsPrimary THA and TKA generate substantial waste and carbon emissions, with low recycling rates across institutions. These findings provide benchmark data to inform sustainability initiatives, optimize resource use, and guide standardized environmental assessment frameworks in arthroplasty.
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